• See Also
  1. Inhaled Corticosteroid
  2. Asthma Management
  • Indications
  1. Inhaled Corticosteroids are the most important agent in Asthma Management
  2. Indicated as daily maintenance agents in all persistent Asthma
    1. Mild Persistent Asthma
    2. Moderate Persistent Asthma
    3. Severe Persistent Asthma
  • Dosing
  • Budesonide DPI (Pulmicort Flexhaler or Turbuhaler)
  1. Use child dosing for age 6 to 11 years old
  2. Dose per puff
    1. U.S. (Pulmicort flexhaler): 90 or 180 mcg/puff (with 120 puffs per Inhaler)
    2. Canadian (Pulmicort turbuhaler): 100, 200 or 400 mcg/puff (with 200 puffs per Inhaler)
  3. Low dose
    1. Adult: 200 to 400 mcg/day (180 mcg Inhaler, 1-2 puffs daily)
    2. Child: <200 mcg/day (90 mcg Inhaler, 1-2 puffs daily)
  4. Medium dose
    1. Adult: 400 to 800 mcg/day (180 mcg Inhaler, 1-2 puffs twice daily)
    2. Child: 200 to 400 mcg/day (180 mcg Inhaler, 1-2 puffs daily)
  5. High dose
    1. Adult: 800 to 1200 mcg/day (180 mcg Inhaler, 3 puffs twice daily)
    2. Child: >400 mcg/day (180 mcg Inhaler, 1-2 puffs twice daily)
  • Dosing
  • Budesonide Nebulizer Inhalation Suspension (Pulmicort Respules or Nebuamp)
  1. Concentrations: 0.125, 0.25 or 0.5 mg/ml ampules (Pulmicort Respules or in Canada, Nebuamp)
  2. Dosing Child Age 6 to 11 years
    1. Low dose: 0.25 to 0.5 mg daily
    2. Medium dose: 0.5 to 1 mg daily
    3. High dose: >1 mg daily
  • Medications
  • Combinations
  1. Formoterol/Budesonide (Symbicort)
    1. See Single Maintenance and Reliever Therapy (SMART Asthma Management Protocol)
  2. Albuterol/Budesonide (Airsupra)
    1. Available in 2024, at $475 per Inhaler
      1. Contrast with cost of generic Albuterol ($30) and generic Corticosteroid (e.g. mometasone, $100)
    2. Use Formoterol/Budesonide instead
      1. Albuterol lasts 6 hours, in contrast to 12 hours for Formoterol
      2. Avoid Airsupra in SMART Asthma Management Protocol
    3. References
      1. (2024) Presc Lett 31(4): 19-20
  • Adverse Effects
  1. See Inhaled Corticosteroid
  2. Milk Protein Allergy reaction risk (Pulmicort flexhaler)
  • Drug Interactions
  1. Strong CYP3A4 Inhibitors (e.g. Ketoconazole)
    1. May increase serum Ciclesonide levels (risk of adrenal suppression)
  • Efficacy
  1. See Inhaled Corticosteroid
  • Safety
  1. Pregnancy Category B
  2. Unknown Safety in Lactation
  • Resources
  1. Budesonide DPI or Pulmicort Flexhaler (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=54234b7d-3bcc-4809-1881-1d21484856a0
  2. Budesonide Nebulizer Inhalation Suspension or Pulmicort Respules (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=33cd9834-76df-4f26-3fa2-aab6b9eee8f2
  • References
  1. (2022) Comparison of Asthma Medications, Presc Lett, #381217
  2. (2020) Drugs for Asthma, Med Lett Drug Ther 62: 193-200