From the FDA Drug Label
Budesonide inhalation suspension is an inhaled corticosteroid indicated for: Maintenance treatment of asthma and as prophylactic therapy in children 12 months to 8 years of age
The recommended first line inhaled corticosteroid is budesonide.
- Key points:
- Indicated for maintenance treatment of asthma
- Prophylactic therapy in children 12 months to 8 years of age
- Start with the lowest recommended dose: 0.5 mg once daily or 0.25 mg twice daily 1
From the Research
The first-line inhaled corticosteroid (ICS) typically recommended for asthma treatment is low-dose fluticasone propionate, with common starting doses of 88-220 mcg twice daily for adults. This recommendation is based on the most recent and highest quality study available, which compared the efficacy and safety of fluticasone propionate to other inhaled corticosteroids, such as beclomethasone dipropionate and budesonide 2. The study found that fluticasone propionate produced a significantly greater improvement in lung function and symptoms compared to beclomethasone dipropionate and budesonide, even when given at half the dose.
Some key points to consider when initiating ICS therapy include:
- Proper inhaler technique, including rinsing the mouth after use to prevent oral thrush
- Starting treatment at the lowest effective dose and titrating based on symptom control
- Regular follow-up to assess response and adjust therapy as needed
- Considering combination therapy with a long-acting beta-agonist for patients with more severe asthma
Other good options for ICS therapy include:
- Beclomethasone dipropionate (40-80 mcg twice daily)
- Budesonide (180-360 mcg twice daily)
- Mometasone furoate (110-220 mcg once or twice daily)
It's worth noting that ICS medications are generally safe with minimal systemic absorption at recommended doses, making them appropriate for long-term management of persistent asthma 3, 4. However, it's essential to monitor patients for potential side effects, such as hoarseness and oral candidiasis, and adjust therapy accordingly.
In terms of specific dosing, the study by 2 found that fluticasone propionate given at half the daily dose of beclomethasone or budesonide led to small improvements in measures of airway calibre, but it appears to have a higher risk of causing hoarseness when given at the same daily dose. Therefore, it's recommended to start with a low dose of fluticasone propionate, such as 88-220 mcg twice daily, and adjust as needed based on symptom control and side effects.