Budesonide Suspension to Pulmicort DPI Dose Equivalence
Budesonide 0.25 mg nebulized suspension is considered a low-dose inhaled corticosteroid for young children, and there is no direct equivalent dose for Pulmicort DPI (dry powder inhaler) because the DPI formulation is not approved or established for children under 5 years of age. 1
Age-Specific Formulation Considerations
The key issue is that these are different formulations designed for different age groups:
Budesonide inhalation suspension (0.25 mg) is specifically FDA-approved for children as young as 12 months and is the only inhaled corticosteroid with this approval for children under 4 years of age 1, 2
Budesonide DPI (Pulmicort Turbuhaler) is only established for children 5-11 years and adults, with low doses starting at 180-400 mcg for children 5-11 years 1
Why Direct Conversion Is Not Appropriate
Different delivery systems are not interchangeable on a microgram-per-microgram basis:
The EPR-3 guidelines explicitly state that "preparations are not interchangeable on a mcg or per-puff basis" 1
Young children under 4 years require delivery through a face mask that fits snugly over nose and mouth, which affects the actual delivered dose 1
The suspension formulation must be delivered via jet nebulizer (ultrasonic nebulizers are ineffective for suspensions) 1
Practical Clinical Approach
If transitioning a child from nebulized suspension to DPI:
Wait until the child is at least 5 years old before considering DPI formulation 1
Start with the low-dose range for DPI (180-400 mcg/day) for children 5-11 years, which would represent comparable low-dose ICS therapy 1
The 0.25 mg suspension dose (administered twice daily as 0.125 mg BID) represents low-dose therapy for children 0-4 years 3
Dosing Frequency
Both formulations can be administered twice daily: