From the FDA Drug Label
The recommended starting dose and highest recommended dose of budesonide inhalation suspension, based on prior asthma therapy, are listed in the following table. Previous Therapy Recommended Starting Dose Highest Recommended Dose Bronchodilators Alone 0.5 mg total daily dose administered twice daily in divided doses 0.5 mg total daily dose Inhaled Corticosteroids 0. 5 mg total daily dose administered twice daily in divided doses 1 mg total daily dose Oral Corticosteroids 1 mg total daily dose administered as 0.5 mg twice daily 1 mg total daily dose Dosing recommendations based on previous therapy are as follows: Bronchodilators alone: 0.5 mg once daily or 0.25 mg twice daily Inhaled corticosteroids 0.5 mg once daily or 0. 25 mg twice daily up to 0.5 mg twice daily Oral corticosteroids: 0.5 mg twice daily
The dosing for a low-dose corticosteroid (CS) inhaler is as follows:
- Bronchodilators alone: 0.5 mg once daily or 0.25 mg twice daily
- Inhaled corticosteroids: 0.5 mg once daily or 0.25 mg twice daily up to 0.5 mg twice daily
- Oral corticosteroids: 0.5 mg twice daily The dose should be titrated downwards once asthma stability is achieved 1.
From the Research
Dosing for Low-Dose Corticosteroid (CS) Inhaler
- The Global Initiative for Asthma guidelines define daily maintenance doses of 100 to 250 μg of fluticasone propionate or equivalent as low doses for adults with asthma 2.
- A systematic review found that initial moderate doses of inhaled corticosteroids (ICS) are equivalent to starting with a high dose and stepping down, and are more effective than initial low ICS doses 3, 4.
- The optimal starting dose of ICS is not clearly established, but recent reviews demonstrate a relatively flat efficacy curve for ICS and increasing side effects with increasing ICS doses 4.
- Commencing ICS at a moderate dose is equivalent to commencing with a high dose ICS and down-titrating, and initial moderate ICS dose appears to be more effective than initial low ICS dose 4.
- A review of the literature found that three patients needed to be treated with fluticasone 100 μg daily to prevent worsening asthma, and the dose-response curve for side effects was steep 5.
Key Findings
- Low-dose inhaled corticosteroids are defined as 100 to 250 μg of fluticasone propionate or equivalent per day 2.
- Moderate doses of ICS (400-800 μg/day beclomethasone or equivalent) are more effective than low doses (<400 μg/day) and equivalent to high doses (>800 μg/day) 3, 4.
- The use of low-dose inhaled corticosteroids is supported by level 1 evidence, and clinicians should review doses of inhaled corticosteroids used for treating patients with asthma 5.