Table 1. UNC Experience: Recommendations for tCS and PPI therapy.

Topical Corticosteroids (tCS)  Dosing typically divided twice daily
	Initial Dosing  6–12 week period		Maintenance Dosing*		Notes
Drug	Children	Adolescents &  Adults**	Children	Adolescents  & Adults**
Fluticasone  Proprionate 220  mcg Inhaler	880–1760  mcg/day	1760 mcg/day	440–880  mcg/day	880–1760  mcg/day	No eating/drinking/brushing teeth for 30 minutes after each dose Do not use a spacer: Puff directly into mouth & swallow
Budesonide  Slurry  0.25 mg/2 mL  respules  OR  0.5 mg/2 mL  respules; PLUS  thickening  agent***	1 mg/day	2 mg/day	0.5  mg/day	1 mg/day	No eating/drinking/brushing teeth for 30 minutes after each dose Use 0.25 mg respules instead of 0.5 mg respules if a larger volume desired
Proton Pump Inhibitors (PPI)
Drug	Children <10 years old		Adolescents & Adults		Notes
Lansoprazole	2 mg/kg/day max divided bid		30 mg twice daily		Initial treatment 8–12 weeks to  assess response  If response, can attempt to  wean dosing and evaluate for  minimal effective clinical dose  Ideally give PPI 30 minutes  before meals
Omeprazole	2 mg/kg/day divided bid		20–40 mg/day divided bid
Pantoprazole	2 mg/kg/day max divided bid		20–40 mg twice daily
Esomeprazole	2 mg/kg/day max divided bid		20–40 mg once daily
Rabeprazole	--		20 mg twice daily
Dexlansoprazole	--		60 mg daily

^*Goal is to use the lowest effective dose, but few data to support this approach or any maintenance approach; recent literature suggests that some patients relapse with tCS dose reduction (118)

^**Some have used cut-off from children to adults as >5 feet tall (109)

^***Example regimens include mixing contents of each respule with 5 grams of sucralose (1 packet of sucralose = 1 gram) or 2.5 mL Neocate Nutra per mg of budesonide to make total volume of 8–12 mL (96)