Budesonide inhaler: uses, side effects and cautions

Budesonide is a steroid, more precisely a corticosteroid, which mimics hormones normally made in the adrenal glands. Breathed in, it lands directly on the lining of the airways, where it quietens the immune activity that causes swelling and mucus. In the UK it is used for asthma and for chronic obstructive pulmonary disease (COPD), and the NHS describes the budesonide-only inhaler as usually brown or beige.

Budesonide is also made as a nasal spray, as tablets, capsules and granules for gut and liver conditions, as rectal foam and as a nebuliser liquid. Those are different products with different instructions; the rest of this page concerns the inhaled form.

On its own budesonide cannot rescue you from a flare of coughing, wheezing and breathlessness, so most people are given a separate reliever as well. The exception is the combination with formoterol, a fast-acting and long-lasting bronchodilator. For asthma this combination may be set up as maintenance and reliever therapy, often shortened to MART, in which one inhaler is used daily and also when symptoms appear. According to the NHS people with COPD are usually given a combined inhaler.

Not every budesonide-formoterol prescription is a MART plan; some are a plain preventer used with a separate rescue inhaler, so your written plan and the leaflet decide how yours is used.

Most adults can use budesonide inhalers for asthma or COPD, and babies and children can use them for asthma, although some brands suit only children aged 5 and over and some only adults. Nebulised budesonide in anyone under 18 is used only on a specialist doctor's advice so that progress can be watched.

Before starting, the NHS asks you to tell a doctor or nurse if you:

• have ever reacted badly to budesonide or any other medicine

• have had tuberculosis

• take, or have lately taken, other steroid medicines

• are pregnant or trying to conceive

Strengths vary, so the number of puffs is set by your doctor or specialist nurse. The NHS gives the usual preventer pattern as 1 or 2 puffs once or twice daily and notes that some people are told to take more than 2 puffs at a time. The goal is the lowest dose that keeps symptoms controlled, and a personal action plan, if you have one, tells you when to step up. If an inhaler also contains formoterol and is used for symptom relief, the total can reach up to 12 puffs a day, and the NHS asks you to tell your doctor if you need more than 8 in a day.

There are pressurised, breath-actuated and dry-powder devices. With a pressurised device a spacer is advised, particularly at high doses and always for children aged 15 and under. The NHS warns against swapping spacers without advice because different spacers can deliver different amounts. Put the cap back on after use, remove the mouthpiece cover before each dose and shake the device 4 or 5 times to clear loose objects. If you miss a dose, take it when you remember unless the next is nearly due; do not add extra to make up. Using a bit too much is unlikely to cause harm, but speak to a pharmacist or doctor if you are worried.

More than 1 in 100 people develop oral thrush, a dry or sore throat or a hoarse voice. Rinsing with water or brushing teeth after each dose reduces the risk, and a pharmacist can suggest an antifungal gel; carry on with the inhaler during treatment.

With high doses over more than a few months, or with other steroids and certain HIV or antifungal medicines, the adrenal glands may become underactive. The NHS advises calling a doctor or 111 straight away for fever and chills, a persistent cough or mouth sores that signal infection, for repeated vomiting, faintness, muscle weakness and weight loss that may signal adrenal insufficiency, and for blurred vision or a cloudy lens, which can be linked to glaucoma or cataract. A gradually puffy face with weight gain around the upper back or belly should be raised with a GP. A swollen mouth, lips, tongue or throat is an anaphylaxis warning and needs 999.

Suspected side effects can be reported to the Yellow Card scheme.

Children and teenagers on high doses for a long time may grow a little more slowly; the NHS puts that risk below 1 in 10,000 and notes that adult height seems little affected. Their height and weight are tracked. Adults on high doses, by inhaler or nebuliser, have a higher chance of adrenal problems or osteoporosis, so clinicians monitor them and may suggest bone-protecting treatment, calcium-rich food and regular exercise.

A pharmacist or doctor decides whether you need a red steroid emergency card, a blue treatment card for high doses, or both, and you show them to any doctor or dentist. Check with a pharmacist before combining budesonide with HIV medicines such as ritonavir or cobicistat, antifungals such as itraconazole, or any other steroid in cream, tablet, injection, spray or drop form.

Budesonide inhalers can be used safely in pregnancy according to the NHS, because very little reaches the blood and almost none reaches the baby; extra budesonide can be taken if asthma needs it. It is also considered fine while breastfeeding, and there is no evidence of an effect on fertility or contraception.

Do not stop without advice: wheeze, chest tightness and cough may come back, and a sudden stop can bring drowsiness, nausea, tiredness, headache and poor appetite. You do not need to stop before an operation, but tell the team. You can drink alcohol, and driving is rarely affected unless your eyesight is. Not smoking makes the treatment work better.