Budesonide Nebulization Dosing in Pediatric Patients

Age-Specific Dosing Recommendations

For pediatric patients, the American Academy of Allergy, Asthma, and Immunology recommends budesonide inhaled suspension for nebulization should be dosed at 0.25-0.5 mg twice daily for children 0-4 years of age for low-dose therapy, and >0.5-1.0 mg twice daily for medium-dose therapy 1, 2, 3
The American Academy of Pediatrics recommends a low daily dose of 0.25-0.5 mg for children 0-4 years of age 1, 2
The American Academy of Allergy, Asthma, and Immunology recommends a medium daily dose of >0.5-1.0 mg for children 0-4 years of age 1, 2
Budesonide nebulizer suspension is the only inhaled corticosteroid with FDA-approved labeling for children <4 years of age 2

For children <4 years of age, the American Academy of Pediatrics recommends using a face mask that fits snugly over nose and mouth 2
The American Academy of Allergy, Asthma, and Immunology advises avoiding nebulizing in the eyes 2
The American Academy of Pediatrics recommends washing face after each treatment to prevent local side effects 2
The dose may be administered twice daily, as recommended by the American Academy of Allergy, Asthma, and Immunology 2

Budesonide suspension is compatible with albuterol, ipratropium, and levalbuterol nebulizer solutions in the same nebulizer, according to the American Academy of Allergy, Asthma, and Immunology 2
The safety and efficacy of inhaled corticosteroids in children <1 year has not been established, as stated by the American Academy of Pediatrics 2

Common side effects include cough, dysphonia, and oral thrush (candidiasis), as reported by the American Academy of Allergy, Asthma, and Immunology 2
In high doses, systemic effects may occur, though studies are not conclusive, according to the American Academy of Allergy, Asthma, and Immunology 2
In low-to-medium doses, suppression of growth velocity has been observed in children, but this effect may be transient, as noted by the American Academy of Pediatrics 2

The most important determinant of appropriate dosing is the clinician's judgment of the patient's response to therapy, as recommended by the American Academy of Allergy, Asthma, and Immunology 2
Once asthma control is achieved, the dose should be carefully titrated to the minimum dose required to maintain control, according to the American Academy of Allergy, Asthma, and Immunology 2