Budesonide Inhaler

1. Introduction

Budesonide inhalers, commonly marketed under brand names such as Pulmicort, Symbicort, and Budecort, are corticosteroid inhalers used to manage asthma and chronic obstructive pulmonary disease (COPD). They reduce airway inflammation, preventing symptoms such as wheezing, breathlessness, and coughing.

2. Indications

  • Approved Indications:
    • Maintenance treatment of asthma in adults and children.
    • Maintenance treatment of COPD (in combination inhalers such as Symbicort).
  • Off-Label Uses:
    • Eosinophilic bronchitis.

3. Dosage

  • Adults and Children ≥12 years:
    • Low dose: 200–400 mcg twice daily.
    • Medium dose: 400–800 mcg twice daily.
    • High dose: 800–1600 mcg twice daily (severe cases).
  • Children (6–12 years):
    • Low dose: 100–200 mcg twice daily.
    • Maximum dose: 400 mcg twice daily.

Dosage should be individualised based on asthma severity. For COPD, combination inhalers are typically used.

4. Administration

  • Use via a metered-dose inhaler (MDI), dry powder inhaler (DPI), or nebuliser (in liquid form).
  • Shake the MDI well before each use.
  • Use a spacer device for better drug delivery and to reduce oropharyngeal side effects, particularly in children.
  • Rinse the mouth with water after each use to prevent oral thrush.

5. Forms Available

  • Metered-Dose Inhaler (MDI): 100 mcg, 200 mcg per actuation.
  • Dry Powder Inhaler (DPI): 100 mcg, 200 mcg, 400 mcg per actuation.
  • Nebuliser Solution: 0.25 mg/mL, 0.5 mg/mL, 1 mg/mL.

6. Side Effects

6.1. Common Side Effects

  • Oral thrush (candidiasis).
  • Hoarseness or dysphonia.
  • Sore throat.

6.2. Less Common Side Effects

  • Cough or bronchospasm.
  • Skin bruising.

6.3. Rare but Serious Side Effects

  • Adrenal suppression (in high doses or prolonged use).
  • Growth suppression in children (rare).
  • Glaucoma or cataracts with long-term use.

7. Warnings

  • Not for use in acute asthma attacks; use a short-acting beta-agonist (e.g., salbutamol) for immediate relief.
  • High doses or prolonged use may lead to systemic corticosteroid effects.
  • Caution in patients with untreated respiratory infections or tuberculosis.

8. Precautions

  • Use the lowest effective dose to control symptoms.
  • Monitor growth in paediatric patients on long-term therapy.
  • Avoid abrupt discontinuation, especially in high-dose users.

9. Interactions

  • Drug-Drug Interactions:
    • CYP3A4 inhibitors (e.g., ketoconazole, ritonavir) may increase systemic corticosteroid exposure.
  • Drug-Food Interactions:
    • No significant interactions reported.

10. Monitoring Parameters

  • Symptom control and frequency of exacerbations.
  • Regular assessment of inhaler technique.
  • Monitoring for side effects, including oral thrush and growth suppression in children.

11. Use in Children

  • Approved for children aged 6 years and above.
  • Use with a spacer device for better delivery and to minimise side effects.

12. Use in Pregnancy

  • Generally considered safe during pregnancy.
  • Use the lowest effective dose.
  • Benefits of controlling asthma outweigh the potential risks.

13. Use in Elderly

  • No specific dosage adjustments required.
  • Monitor for osteoporosis and systemic corticosteroid effects.

14. Use in Kidney Disease

  • No dosage adjustments required; systemic absorption is minimal.

15. Use in Liver Disease

  • Use with caution in severe hepatic impairment due to potential systemic corticosteroid exposure.

16. Patient Counselling Points

  • Explain the importance of regular use, even if symptoms are controlled.
  • Demonstrate proper inhaler technique to ensure effective delivery.
  • Advise rinsing the mouth with water after use to prevent oral thrush.
  • Highlight that the inhaler is not for acute symptoms; carry a reliever inhaler for emergencies.
  • Emphasise adherence to prescribed doses and follow-up appointments.

17. Table of Brand Names, Manufacturers, and Prices

Brand NameManufacturerPrice (USD)
PulmicortAstraZeneca$35–50 (200 doses, 200 mcg)
SymbicortAstraZeneca$45–60 (120 doses, 160/4.5 mcg)
BudecortCipla$15–25 (200 doses, 200 mcg)
Generic OptionsVarious$10–20 (200 doses, 200 mcg)

18. FAQs (15 Questions)

  1. What is budesonide inhaler used for?
    It is used to manage asthma and COPD by reducing airway inflammation.
  2. How does budesonide work?
    It suppresses inflammation in the airways, preventing asthma and COPD symptoms.
  3. Can budesonide be used during an asthma attack?
    No, it is not for acute attacks. A short-acting beta-agonist should be used for immediate relief.
  4. What are the common side effects of budesonide?
    Oral thrush, hoarseness, and sore throat.
  5. Is budesonide safe for children?
    Yes, for children aged 6 years and above, but with appropriate dosage and monitoring.
  6. Can pregnant women use budesonide?
    Yes, it is generally safe, with benefits outweighing potential risks.
  7. How should budesonide be taken?
    Use the inhaler as prescribed, and rinse your mouth with water after each dose.
  8. Can budesonide inhaler cause weight gain?
    No, weight gain is unlikely with inhaled corticosteroids at standard doses.
  9. How long does it take for budesonide to work?
    Improvement may be seen within 24–48 hours, but full benefits may take 1–2 weeks.
  10. Does budesonide interact with other medications?
    CYP3A4 inhibitors like ketoconazole may increase systemic absorption.
  11. Can budesonide be used for children under 6 years?
    Inhaled budesonide may be used via nebulisation in younger children under medical supervision.
  12. How should budesonide inhalers be stored?
    Store at room temperature, away from direct sunlight and moisture.
  13. What happens if I miss a dose?
    Take it as soon as you remember, but skip it if it’s close to the next dose.
  14. Can budesonide cause osteoporosis?
    Long-term use at high doses may increase the risk of osteoporosis.
  15. What should I do if symptoms persist despite using budesonide?
    Consult your healthcare provider for dosage adjustments or additional therapy.