Budesonide (inhaler), sold under the brand name Pulmicort (Flexhaler), is an oral inhaler that is typically used to treat asthma and chronic obstructive pulmonary disease (COPD). In this article, we answer some of the most common questions about budesonide, including how to use it, how long it takes to work, and its side effects.

What is budesonide and how does it work?

Budesonide belongs to a class of drugs known as corticosteroids. It comes in the form of white to off-white, tasteless, and odorless powder that is put into inhaler devices. It needs to be administered through a mouth inhalation route so that the drug can go directly into the lungs. Budesonide reduces the irritation and swelling in the airways, and ultimately, makes your breathing easier.

What is budesonide (Pulmicort) used for?

Budesonide (Pulmicort) is normally used to maintain control over asthma symptoms such as chest tightness, wheezing and shortness of breath.

It is important to note that, budesonide (Pulmicort) is not a quick-relief inhaler, which means it shouldn’t be used to relieve sudden asthma attacks. It must be taken at regular intervals as recommended by your doctor. If an asthma attack occurs, use your prescribed reliever inhaler, such as a bronchodilator, for emergency relief of acute or life-threatening episodes of asthma.

How to use Pulmicort Flexhaler?

There are different types of budesonide inhalers and one of them is Pulmicort Flexhaler. It's very important to use your inhaler properly so that you get the right amount of budesonide into your lungs and the most benefit from your medicine.

Read the information leaflet that comes with the product before using the inhaler. In the leaflet, you can find some instructions and diagrams to show you how to use the inhaler correctly, including how to keep it clean (to prevent infections) and how long can you use it before needing a replacement.

Here is the step-by-step guide on how to use the Pulmicort Flexhaler:

• Turn the protective cover and lift it off.
• If this is your first time using a new Pulmicort Flexhaler, you must prime it by twisting the brown grip fully to the right as far as it gets, before twisting it back again fully to the left.
• Then, you will hear a click. Repeat. Priming only applies to a new inhaler. You don’t need to do this again even if the inhaler hasn’t been used for a long time.
• Check that you are using the correct strength as prescribed by your doctor. The dosage is based on your medical condition and response to treatment.
• Breath out, then inhale the medication by mouth. While inhaling, breathe calmly and deeply (around 10 seconds) until the mist stops.
• Put the protective cap back on and twist to shut it. Always keep the inhaler clean and dry with the cover in place in the upright position (mouthpiece on top).
• After each treatment, rinse and gargle your mouth with water to prevent dry mouth,thrush and hoarseness. Don’t swallow the rinse water.
• Wash your face/the area where the mouthpiece of the inhaler has touched your skin to prevent skin reactions and irritation.
• Avoid getting the medication in your eyes.

You may also find the following video from Boston Children's Hospital helpful.

How long does it take for budesonide (Pulmicort) to work?

Improvement in your condition can occur within 24 hours after the treatment but maximum effects are usually after 1 to 2 weeks, or longer.

It is important that you use this medicine regularly to get the full benefit from it. Don’t increase/decrease the dose, use it more frequently, or stop using budesonide without first consulting your doctor. If after the first 2 weeks of usage you don’t feel any improvement or if your condition gets worse, talk to your doctor.

How often can I take budesonide (Pulmicort Flexhaler)?

The recommended starting dose and the highest recommended dose of Pulmicort Flexhaler, based on prior asthma therapy, are listed below:(Pulmicort Flexhaler comes as 90mcg/actuation or 180mcg/actuation inhaler)

Adults:

• Recommended starting dose: 180mcg to 360 mcg twice daily
• Highest recommended dose: 720 mcg twice daily

Children:

• Recommended starting dose: 200 180 mcg twice daily
• Highest recommended dose: 400 360 mcg twice daily

What should I do if I have an asthma attack?

As mentioned previously, budesonide isn’t a quick-relief drug for asthma attacks. Ask your doctor ahead of time what you should do if you have new or worsening shortness of breath, wheezing, increased sputum, or cough. You’re likely to be prescribed bronchodilators for a reliever inhaler.

Take note of how many times in a day you use your quick-relief inhaler and bring this data to your next health consultation. Depending on the condition, if you use the quick-relief inhaler too frequently, your doctor may higher increase the budesonide (Pulmicort) dose or ask you to try other medications.

What are the side effects of budesonide (Pulmicort)?

Budesonide inhalation may cause side effects. The list below includes some of the most common side effects but is not a complete list. Tell your doctor if any of these symptoms persist or worsen:

• headache, stuffy or runny nose, sore throat
• diarrhea, loss of appetite, stomach pain
• difficulty falling asleep or staying asleep
• neck or back pain
• nosebleeds

Some side effects can be serious. If you experience any of the following symptoms, call your doctor immediately or get emergency medical treatment:

• rash, hives, itching
• swelling of the part of your body, such as face, throat, tongue, or lips
• white spots or sores in your mouth
• hoarseness, difficulty breathing or swallowing, wheezing, cough, chest pain
• fever, chills, or other signs of infection
• tiredness, nausea, vomiting
• changes in vision

In rare cases, people who used budesonide for a long-time may:

• develop glaucoma or cataracts
• increase the risk of developing osteoporosis (a condition in which the bones become thin and weak and break easily)

How to know when my Pulmicort Flexhaler is empty?

The label on the box or cover will tell you how many doses are in your Pulmicort Flexhaler. On the body of Pulmicort Flexhaler, there is a dose indicator window just below the mouthpiece.

• When a red mark appears at the top of the window, there are 20 doses of medicine remaining. You should get your next Pulmicort Flexhaler (budesonide).
• When the red mark reaches the bottom of the window, your inhaler should be discarded as it may no longer deliver the correct amount of medication.

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