Pulmicort (budesonide) is an inhaled corticosteroid. Pulmicort is approved for the long-term treatment of asthma. It is made by AstraZeneca. Pulmicort comes as a dry powder inhaler (Pulmicort Flexhaler) and as a liquid suspension for use with a jet nebulizer (Pulmicort Respules).1,2 Pulmicort Flexhaler is approved for people ages six years and up.1 Pulmicort Respules is approved for children from 12 months to eight years.2
Do not take Pulmicort if you are having an asthma attack. It does not work quickly enough. Use a rescue inhaler (short-acting beta agonist) instead.
How does Pulmicort work?
Inhaled corticosteroids such as Pulmicort reduce inflammation in the airways.1,2 Corticosteroids affect many different types of inflammatory cells, including eosinophils and mast cells. They also affect signaling chemicals that have a role in inflammation such as histamine, leukotrienes, and cytokines.
How is the Pulmicort Flexhaler taken?
Ask your health care provider or respiratory therapist to show you how to use your inhaler properly.
Pulmicort Flexhaler is an dry powder inhaler. It comes in strengths of 90 mcg and 180 mcg. It should be taken two times per day (Table 1).3 Your health care provider will tell you how many inhalations to take.
You must prime your Flexhaler before the first use.3 Open your Flexhaler according to step 1 in Table 1. Twist the grip as far as it will go in one direction, and then twist it all the way back the other way. You can twist it in either direction first. You will hear a click during one of the twists. Repeat the twisting action one more time. You do not need to prime your Flexhaler again, even if it is unused for a long period of time.
Table 1. Using your Pulmicort Flexhaler
- Hold the brown grip of the inhaler so that the white cover points up. Turn the cover and lift it up.
- To load a dose: Hold the grip in one hand and the middle of the inhaler with the other hand. Twist the grip as far as it will go in one direction, and then twist it all the way back the other way. You can twist it in either direction first. You will hear a click during one of the twists.
- Turn away from the inhaler and breathe out until your lungs are empty. (If you breathe into the inhaler, you will lose the dose of medicine.)
- Put your lips on the mouthpiece. Breathe in deeply and forcefully through your mouth. (You may not feel or taste the medicine. Do not take another dose.)
- Remove the inhaler from your mouth and exhale.
- If your provider has prescribe more than one inhalation, repeat the procedure.
- Place the cover back on your inhaler.
- Rinse your mouth with water and spit out the water. This step will help to prevent thrush, a fungal infection of the mouth.
- Read the Patient Information that comes with your inhaler for complete instructions.
Pulmicort Flexhaler™ [patient information]. Wilmington, DE: AstraZeneca; 2010.
Pulmicort Respules is taken with a jet nebulizer.4 A nebulizer turns a liquid medication into a fine mist that your child inhales. Ask your health care provider or respiratory therapist to show you how to use your jet nebulizer properly.How is Pulmicort Respules taken?
Pulmicort Respules should be taken once or twice per day (Table 2).4 Each ampule (sealed vial) contains 2 mL of liquid. Pulmicort Respules come in three strengths: 0.25 mg/2mL, 0.5 mg/2 mL, and 1 mg/2mL Your health care provider will recommend the best dose for your child and tell you how many daily doses your child should take.
Table 2. Using Pulmicort Respules
- When you are ready to use the medication, open the sealed foil envelope containing the Pulmicort Respules. Record the date on the back of the envelope. The medication in the envelope must be used within two weeks of opening.
- Take one single-dose ampule (sealed vial) from the strip.
- Store the remainder of the ampules in the foil envelope. This protects them from light.
- Shake the ampule in a gentle, circular motion.
- Hold the ampule upright. Do not squeeze. Twist off the top to open.
- Place the open end of the ampule into the nebulizer cup. Slowly squeeze all the medication into the medicine cup.
- Use your jet nebulizer according to the directions. If your child uses a facemask, it should fit snugly. A good fit is important for getting the right amount of medication and to prevent the nebulized medication from getting in the eyes.
- Have your child rinse his/her mouth with water and spit out the water. This step will help to prevent thrush, a fungal infection of the mouth. Wash your child’s face after using a facemask to prevent skin effects.
- Read the Patient Information that comes with your Pulmicort Respules for complete instructions.
Pulmicort Respules® [patient information]. Wilmington, DE: AstraZeneca; 2010.
What should I do if I miss a dose of Pulmicort?
If you miss a dose of Pulmicort, just take the next dose at the regular time.4 Do not use Pulmicort more often than your health care provider has prescribed.
What are the recommendations for storing, cleaning, and discarding Pulmicort?
Keep the Pulmicort Flexhaler at room temperature (68˚F and 77˚F) in a dry place.1 Wipe the mouthpiece of your Flexhaler once a week with a dry tissue.3 Do not get your inhaler wet. Throw the Flexhaler away when the counter reads 0. You have used all the medication in it.
Store Pulmicort Respules upright at room temperature (68˚F and 77˚F).2 Keep them in the foil envelope until they are used to protect them from the light. Ampules can be used for two weeks after opening the envelope.
What are the possible side effects of taking Pulmicort?
Taking Pulmicort could cause your airways to tighten suddenly (“bronchospasm”).1,2 This side effect can happen right after using the inhaler or nebulizer. Take your rescue inhaler and call your health care provider.
Common side effects of Pulmicort are colds (sore nose and throat, stuffy and runny nose), hay fever, ear infections, nausea, and stomach flu.3,4 Additional side effects of Pulmicort Respules are cough, nosebleed, pink eye, and rash.4
Inhaled corticosteroids, such as Pulmicort, can cause thrush, a fungal infection in your mouth.1,2 You can help to prevent this by rinsing your mouth with water after using the inhaler or nebulizer and spitting out the water.
Corticosteroids can lower your immune system, so you are more likely to get an infection.3,4 Symptoms of an infection are fever, pain, aches, chills, fatigue, nausea, or vomiting. Avoid contact with people who have chicken pox, measles, or other contagious diseases. Let your provider know if you have any infections, including tuberculosis or herpes simplex of the eye.3,4 This is not an exhaustive list of side effects that may occur with Pulmicort. Please make sure to discuss with your doctor.
Children who use corticosteroids may grow more slowly. Your child’s growth should be checked regularly.3,4
Are there people who should not take Pulmicort?
Do not take Pulmicort if you are having an asthma attack.1,2 Pulmicort does not work quickly enough. A rescue inhaler should be used instead.
People with a severe milk allergy should not use a Pulmicort Flexhaler.3 If you are allergic to any ingredient in Pulmicort, you should not take this medication.
Tell your health care provider if you have had problems with your liver, eyes, immune system, or osteoporosis.3,4 Taking corticosteroids may worsen these conditions. Extra monitoring or an alternative treatment may be needed. Tell your health care provider about any prescription medications you take, particularly corticosteroids, anti-seizure medicines, immunosuppressants, ketoconzale (Nizoral), or other medications that affect how your liver works.3,4 Let your provider know about over-the-counter medications or supplements that you take.
There are no high-quality studies of Pulmicort in pregnant or breastfeeding women. The National Heart, Lung, and Blood Institute states that budesonide (the active ingredient in Pulmicort) is the preferred inhaled corticosteroid during pregnancy.5 They cite available studies with reassuring safety data. These guidelines also state that women can breastfeed while taking an inhaled corticosteroid.5 A small percentage of budesonide (0.3% to 1%) does pass into the breastmilk.1 The prescribing information for Pulmicort states the drug should only be used during pregnancy if needed, so talk to you doctor about whether to use this medication during pregnancy or breastfeeding.3,4
What evidence do we have that Pulmicort works?
The Flexhaler was compared with fake treatment (placebo) in two high-quality studies.1 One study included 621 adults with mild-to-moderate asthma. The people treated with Flexhaler had more improvement in lung function, fewer daytime and nighttime asthma symptoms, and less use of rescue medications, compared with people who got placebo. Fewer people treated with Flexhaler had to pull out of the trial because their asthma worsened. Flexhaler was studied in 516 children aged six to 17 years with mild asthma. The children treated with Flexhaler had better lung function than children who got placebo.
Pulmicort Respules were studied in three high-quality trials that included 1,018 children, ages six months to eight years.2 Children treated with Pulmicort Respules had fewer day and nighttime asthma symptoms than the children who got placebo. Lung function tests in the older children showed that treatment with Pulmicort Respules improved lung function.
Is there a generic alternative to Pulmicort?
There is no generic alternative to the Pulmicort Flexhaler. Generic budesonide liquid suspensions are available as alternatives to Pulmicort Respules.
- Pulmicort Flexhaler™ [prescribing information]. Wilmington, DE: AstraZeneca; 2010.
- Pulmicort Respules® [prescribing information]. Wilmington, DE: AstraZeneca; 2010.
- Pulmicort Flexhaler™ [patient information]. Wilmington, DE: AstraZeneca; 2010.
- Pulmicort Respules® [patient information]. Wilmington, DE: AstraZeneca; 2010.
- National Heart Lung and Blood Institute. Working group report on managing asthma during pregnancy: Recommendations for pharmacologic treatment. Update 2004. Accessed 1/20/15 at: http://www.nhlbi.nih.gov/files/docs/resources/lung/astpreg_full.pdf