Nebulized Steroids for Respiratory Distress

Recommended Steroid for Nebulization

Budesonide is the recommended steroid for nebulization in patients with respiratory distress, typically administered at a dose of 500 μg, as recommended by the American Thoracic Society 1, 2

For children with croup, 500 μg of nebulized budesonide has been shown to reduce symptoms in the first two hours, with a moderate strength of evidence 1, 2
Budesonide should be administered from jet nebulizers at adequate flow rates to achieve optimal particle sizes of 2-5 μm for proper deposition in the small airways, as suggested by the European Respiratory Society 4
Oxygen should be used as the driving gas for nebulization in acute severe respiratory distress whenever possible, as patients are likely to be hypoxic, according to the British Thoracic Society 4

Patients should rinse their mouth after using nebulized budesonide to prevent oral thrush, as recommended by the American Academy of Pediatrics 3
In severe respiratory distress, nebulized budesonide can be used alongside systemic corticosteroids for more comprehensive anti-inflammatory coverage, with a low strength of evidence 3

Water should never be used for nebulization as it may cause bronchoconstriction when nebulized, as warned by the National Institutes of Health 4
Nebulized steroids should only be used on a doctor's recommendation and are not a first-line treatment for all forms of respiratory distress, according to the American College of Chest Physicians 4
In some cases, a metered-dose inhaler with a spacer may be as effective and cheaper than nebulization, particularly for children, as suggested by the American Academy of Pediatrics 1