Budesonide inhalers

Budesonide inhalers are a steroid medicine that's used for asthma and chronic obstructive pulmonary disease (COPD).

Steroids (also known as corticosteroids) work because they closely copy the effects of natural hormones. Steroid inhalers prevent and reduce the swelling (inflammation) that can happen in your lungs if you have asthma or COPD. This swelling can sometimes make it difficult to breathe.

You can take budesonide using an inhaler (sometimes called a "puffer"), which is usually brown or beige. This is called a preventer inhaler because it helps to prevent you from getting symptoms.

Budesonide on its own does not work as a reliever (a medicine that relieves symptoms when you get them). It cannot treat an asthma attack when you suddenly get coughing, wheezing and breathlessness.

Some inhalers contain budesonide mixed with other medicines that help your breathing (bronchodilators).

A budesonide inhaler containing formoterol can be used as both a preventer and a reliever for asthma and COPD. Brand names include Symbicort Turbohaler, DuoResp Spiromax, Fobumix Easyhaler and WockAIR.

Budesonide also comes as:

• a nasal spray – for allergic rhinitis, hay fever and nasal polyps
• tablets, including tablets that dissolve on your tongue, capsules and granules – for inflammatory conditions such as Crohn's disease, ulcerative colitis, autoimmune hepatitis and eosinophilic oesophagitis
• rectal foam and enemas – for ulcerative colitis
• a nebuliser liquid

If you have severe asthma or COPD, you may need to use a nebuliser. A nebuliser helps you breathe in your medicine as a mist, using a mask or a mouthpiece. You can use a nebuliser in hospital, or you may be given one to manage your condition at home. Budesonide nebuliser liquid comes in individual doses called nebules or respules.

Most adults can use inhalers that contain budesonide for asthma or chronic obstructive pulmonary disease (COPD).

Babies and children can use budesonide inhalers for asthma. Some brands may only be suitable for children aged 5 years old and over, and some may only be suitable for adults to use.

Most adults can use budesonide in a nebuliser.

Children aged under 18 years old can use budesonide in a nebuliser only if it's with advice from a specialist doctor. This is because children need to be monitored to make sure their condition is not getting worse.

Budesonide inhalers are not suitable for some people. To make sure they're safe for you, tell a doctor or nurse if you:

• have ever had an allergic reaction to budesonide or any other medicine
• have ever had TB (tuberculosis)
• are taking or have recently taken other steroid medicines
• are pregnant or trying to get pregnant

The usual dose for budesonide inhalers as a preventer for asthma or chronic obstructive pulmonary disease (COPD) is 1 or 2 puffs, once or twice a day.

Your doctor or asthma nurse may tell you to have more than 2 puffs at a time from your inhaler. It depends on how bad your breathing is and which inhaler you're using.

If you use your inhaler once a day, it may work better if you take it in the evening.

If your inhaler also contains formoterol (a bronchodilator), your doctor or asthma nurse might tell you to also use it when you're wheezy or your chest feels tight. This can be up to 12 puffs a day in total. Let your doctor know if you need to use more than 8 puffs in a day.

It's important to use your budesonide inhaler regularly, even if you do not have any symptoms. This helps to manage your symptoms.

Your dose may go up or down depending on how bad your breathing is. You'll be prescribed the lowest dose that controls your symptoms.

If you've agreed a personal action plan with your doctor or nurse, follow your action plan.

There are different types of budesonide inhaler, including:

• pressurised metered dose inhalers (pMDIs) – these give the medicine in a spray form (aerosol), and you can use these with a spacer
• breath actuated inhalers (BAIs) – these release a spray of medicine as you inhale
• dry powder inhalers (DPIs) – these give the medicine in the form of a dry powder instead of a spray

Speak to your doctor, nurse or pharmacist about which inhaler type is best for you or your child.

It's very important to use your inhaler properly. This is so you get the right amount of budesonide into your lungs and the most benefit from your medicine.

Before using your inhaler, read the information leaflet that comes with it. This leaflet contains instructions and diagrams to show you how to use the inhaler, how to keep it clean, and how long to use it before getting a replacement.

After using your inhaler, always put the lid back on to keep it clean.

If you or your child finds it difficult to use one type of inhaler, speak to your doctor, nurse or pharmacist about trying a different type.

Do not use a budesonide inhaler that belongs to anyone else, even if they're a friend or relative, because it may be different to yours. Their inhaler might contain a different dose of budesonide.

If you're using a pressurised metered dose inhaler (pMDI), your doctor or nurse may give you a spacer to make it easier to use. Spacers can also reduce the risk of steroid side effects affecting your mouth and throat.

A spacer is recommended for anyone using a pMDI that contains a steroid, especially with high doses, and always for children aged 15 years old and under.

A spacer is a plastic container with a mouthpiece and a hole for the inhaler. It makes it easier to get the right amount of budesonide into your lungs. For young children, they're available with a face mask.

Do not change your spacer without speaking to a doctor or nurse first. Different spacers can give you different amounts of medicine.

Your doctor, nurse or a pharmacist can show you how to use a spacer with your inhaler.

Check your inhaler technique

To get the most from your inhaler, it's important to have your technique checked regularly.

If you're not sure how to use your inhaler, or your technique has not been checked for a year, ask your doctor, nurse or a pharmacist to watch you use it.

Watch a video

Asthma + Lung UK has some short videos showing you how to use your inhaler to help you manage your symptoms. You can search by type of inhaler (such as Turbohaler, Spiromax or Easyhaler).

Remove the mouthpiece cover completely before using your inhaler. Check the inside and outside of the mouthpiece to make sure it's clean and there's nothing inside it. Shake the inhaler 4 or 5 times to remove any loose objects.

After use, replace the mouthpiece cover straight away. Firmly push it and make sure it clicks into place.

Always store your inhaler with the mouthpiece cover on.

You'll usually use your budesonide inhaler for a long time. It helps prevent your asthma or COPD getting worse.

It's important to keep using your inhaler even if you feel better.

Do not stop using budesonide without speaking to your doctor or nurse first.

If you have an inhaler to control your asthma or COPD, your breathing problems may return if you suddenly stop using it. You might feel wheezy or short of breath. Your chest may feel tight and you could start to cough.

Suddenly stopping treatment can make you feel unwell. Symptoms can include feeling drowsy, sick or tired, headaches and loss of appetite.

Use your inhaler as soon as you remember, unless it's almost time for your next dose. In this case, skip the missed one and take your next dose at the usual time.

Do not take extra doses to make up for a forgotten dose.

If you forget doses often, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.

Do not stop using budesonide suddenly, even if you feel better, without speaking to your doctor or nurse first.

Using too much budesonide is unlikely to harm you.

If you're worried, talk to your doctor or a pharmacist.

If you're using a steroid inhaler regularly, ask your doctor, nurse or a pharmacist if you need to carry a blue steroid card, or a red steroid emergency card, or both.

If you need any medical or dental treatment, show your blue or red steroid card to the doctor, dentist or pharmacist so they know you're taking budesonide.

These common side effects of budesonide inhalers may happen in more than 1 in 100 people. There are things you can do to help cope with them:

If you get oral thrush, a fungal infection that causes white patches, redness and soreness in your mouth, try rinsing your mouth with water or brushing your teeth after using your inhaler to stop this happening.

You can also ask a pharmacist to recommend a suitable treatment such as an antifungal mouth gel. They may suggest that you see your doctor to discuss the best treatment.

Keep using your budesonide inhaler while using any antifungal treatment.

Try rinsing your mouth with water or brushing your teeth after using your inhaler to stop this happening.

Keep taking the medicine but talk to your doctor, nurse or a pharmacist if this advice does not help or if the side effects bother you or do not go away. They can check that you're using your inhaler correctly.

It's unusual to have any serious side effects when using a budesonide inhaler.

Side effects are more likely if you're on a higher dose of budesonide for a long time (more than a few months).

Speak to a doctor if you get "moon face" (a puffy, rounded face), and weight gain in the upper back or belly. This happens gradually and can be a sign of Cushing's syndrome.

Call your doctor or call 111 straight away if you get:

• a high temperature, chills, a very sore throat, ear or sinus pain, a cough, coughing up more mucus (phlegm), a change in colour of your mucus, pain when you pee, mouth sores or a wound that will not heal – these can be signs of an infection
• a very upset stomach or you're being sick (vomiting), feeling very dizzy or passing out, muscle weakness, feeling very tired, mood changes, loss of appetite and weight loss – these can be signs of adrenal insufficiency
• changes in your eyesight, such as blurred vision or a cloudy lens in the eye – these can be signs of increased pressure in your eyes (glaucoma) or a cataract

Serious allergic reaction

In rare cases, budesonide inhalers may cause a serious allergic reaction (anaphylaxis).

Call 999 now if:

• your lips, mouth, throat or tongue suddenly become swollen
• you're breathing very fast or struggling to breathe (you may become very wheezy or feel like you're choking or gasping for air)
• your throat feels tight or you're struggling to swallow
• your skin, tongue or lips turn blue, grey or pale (if you have black or brown skin, this may be easier to see on the palms of your hands or soles of your feet)
• you suddenly become very confused, drowsy or dizzy
• someone faints and cannot be woken up
• a child is limp, floppy or not responding like they normally do (their head may fall to the side, backwards or forwards, or they may find it difficult to lift their head or focus on your face)

You or the person who's unwell may also have a rash that's swollen, raised, itchy, blistered or peeling.

These can be signs of a serious allergic reaction and may need immediate treatment in hospital.

Children and teenagers

Using budesonide inhalers at higher doses for a long time could possibly slow down the normal growth of children and teenagers. But the risk of this happening is very low, less than 1 in 10,000 people.

Talk to your doctor or asthma nurse if you're worried. They'll be able to explain the benefits and risks of giving your child budesonide inhalers.

Your child's doctor or asthma nurse will monitor their height and weight carefully for as long as they're using this medicine. This will help them spot any slowing down of your child's growth and change their treatment if needed.

Even if your child's growth slows down for a while, it does not seem to have much effect on their eventual adult height.

Your doctor or nurse will always aim to give you or your child the lowest dose of steroids to keep your symptoms controlled. You'll only be given higher doses if you need extra help to deal with your symptoms.

It's important to remember that inhaled steroids are one of the best ways to treat asthma and COPD and reduce your risk of symptoms and asthma attacks.

Talk to your doctor if you're worried. They'll be able to explain the benefits and risks of your child using budesonide inhalers.

Adults

If you use your inhaler as recommended by your doctor, nurse or pharmacist you're unlikely to get any lasting side effects.

Adults taking high doses (either using an inhaler or nebuliser) have an increased risk of getting adrenal gland problems or weak bones (osteoporosis) over time. This is because more of the steroid gets into your body.

Your doctor will monitor you closely and may prescribe medicines to help strengthen your bones. Calcium-rich foods (such as milk and cheese, or non-dairy milks with added calcium) and regular exercise can also help keep bones healthy.

These are not all the side effects of budesonide inhalers. For a full list see the leaflet inside your medicine packet.

Budesonide inhalers can be used safely during pregnancy.

Because the medicine is inhaled into your lungs, very little of it gets into your bloodstream and almost none gets to your baby. Even if a small amount does get to your baby, it will not cause harm.

It's important to keep using your budesonide inhaler in pregnancy to ensure your asthma or chronic obstructive pulmonary disease (COPD) is well controlled. Having breathing difficulties may be dangerous for you and your baby.

You may find that you need extra budesonide during pregnancy. This is fine, and it's safe to increase the dose if you need to.

Contact your doctor or specialist if you're having problems controlling your asthma or COPD.

It's OK to use a budesonide inhaler while you're breastfeeding.

There's not much information about using budesonide inhalers while breastfeeding, but only tiny amounts get into breast milk. Your baby will not be able to absorb a lot of budesonide into their body from the breast milk, so it's unlikely to cause any side effects in your baby.

If you notice that your baby is not feeding as well as usual, or if you have any other concerns about your baby, talk to your health visitor, midwife or doctor as soon as possible.

There's no evidence to suggest that taking budesonide reduces fertility in either men or women.

Budesonide inhalers can be used with most other medicines. But some medicines may affect your inhaler and increase the chance of having side effects.

Check with a pharmacist or your doctor if you're taking:

• medicines used to treat HIV such as ritonavir or cobicistat
• other medicines that contain steroids such as eczema creams, other asthma inhalers, steroid tablets, injections, nasal sprays or eye or nose drops
• antifungal medicines, such as or itraconazole

There's not enough evidence to say that complementary medicines, herbal remedies and supplements are safe to take while using a budesonide inhaler. They're not generally tested for the effect they have on other medicines.

Tell your doctor or pharmacist if you're taking any other medicines, including herbal remedies, vitamins or supplements.