Beclometasone inhaler: uses, side effects and cautions

Beclometasone is a corticosteroid, a synthetic relative of the hormones your adrenal glands make. As an inhaler it is mainly prescribed to prevent asthma symptoms and, less often, to treat chronic obstructive pulmonary disease (COPD). Because it works over days and weeks it is called a preventer, and the inhalers are commonly brown, beige, red or pink according to the NHS.

The same drug also comes as a nasal spray for hay fever and allergic rhinitis, a cream or ointment for eczema and psoriasis and a tablet for ulcerative colitis. This page deals only with the inhaled form.

Asthma is driven by inflammation: the lining of the airways becomes swollen and over-reactive. Beclometasone dampens that immune response, so there is less swelling and the airways are less likely to tighten when exposed to triggers. It prevents coughing and wheezing from developing, but it cannot reverse an attack that has already started.

The NHS says people usually wheeze less or feel less breathless after about 3 to 7 days, and that the full benefit may take several weeks. If wheeze or breathlessness is no better after 7 days, or is worse, the NHS says to let your doctor or nurse know. As protection builds, a separate reliever inhaler should be needed less often.

Most adults can use beclometasone inhalers for asthma or COPD, and most infants and children can use them for asthma, although some brands are only for children aged 5 and above. The NHS asks you to tell your doctor or nurse if you have:

• ever had an allergic reaction to beclometasone or another medicine

• a reason to avoid alcohol, because some brands contain a very small amount

• ever had tuberculosis

• pregnancy or plans for pregnancy

The NHS gives the usual preventer dose as 1 or 2 puffs twice a day, but strengths differ and your asthma or respiratory nurse sets the strength and number of puffs, sometimes up to 4 times a day. The aim is the lowest dose that keeps symptoms controlled. Use it every day, even when you feel well, and follow your personal action plan if you have one.

Inhalers come as pressurised metered-dose devices, breath-actuated devices and dry powder devices. A spacer is advised for anyone using high doses of a pressurised steroid inhaler, and is always recommended for children aged 15 and under; it also lowers the chance of mouth and throat side effects. Never use someone else's inhaler, because the strength may differ. If you miss a dose, take it when you remember unless the next one is nearly due, and do not double up.

Where the inhaler also contains formoterol, a clinician may set up a maintenance-and-reliever plan, sometimes called MART. Total use can then reach up to 8 puffs a day, and the NHS asks you to report needing more. Not every formoterol combination is used that way, so the leaflet and your plan decide.

Because the drug is delivered to the lungs, little reaches the rest of the body and side effects are uncommon. More than 1 in 100 people get oral thrush (white patches, redness and soreness in the mouth), a dry or sore throat, or a hoarse voice. Rinsing with water or brushing your teeth afterwards and using a spacer both help, and a pharmacist can suggest antifungal gel. Keep using the inhaler while thrush is treated.

Higher doses over more than a few months raise the chance of larger effects. The NHS lists a puffy, rounded face and weight gain around the upper back or belly as possible signs of Cushing's syndrome, to raise with a GP. It advises a call to a doctor or NHS 111 for infection signs such as fever and chills, symptoms of low adrenal function such as vomiting, faintness, weakness and weight loss, or eyesight changes that can signal glaucoma or cataract.

Anaphylaxis is rare. Sudden swelling of lips, mouth, throat or tongue needs 999. Wheeze or chest tightness is treated with your reliever, but call 999 or go to A&E if it does not improve. Side effects can be reported to the Yellow Card scheme.

People on high doses, or on several steroids at once such as an inhaler plus a nasal spray, can develop adrenal insufficiency. The NHS says a pharmacist or doctor will judge the risk and may advise a red steroid emergency card, plus a blue steroid treatment card for high-dose inhaled beclometasone. Show the cards to any doctor or dentist who treats you.

In children and teenagers on high doses for long periods, growth can slow slightly; the NHS puts the risk at less than 1 in 10,000 and says height and weight are checked yearly. In adults on high doses, adrenal problems or osteoporosis are rare, about 1 in 10,000, and clinicians may monitor bone health and suggest calcium-rich foods and exercise.

The NHS says beclometasone inhalers may be used in pregnancy because very little reaches the bloodstream, and that uncontrolled lung disease is a danger to mother and baby. Dose increases are safe if needed. Use while breastfeeding is described as fine, and no evidence links it to reduced fertility. It does not affect any contraception.

Check with a pharmacist about HIV medicines such as ritonavir or cobicistat, other steroid products (creams, tablets, injections, nasal sprays, eye or nose drops) and disulfiram or metronidazole because of the tiny alcohol content in some brands. Alcohol itself is fine, and driving is rarely affected unless vision changes. Do not stop suddenly: breathlessness may return and you may feel drowsy, sick, tired or headachy. You need not stop before surgery, but tell the team and show your cards. Smoking makes breathing worse and reduces how well the medicine works.