corticosteroid inhaled

Budesonide

Pulmicort / Rhinocort / Symbicort (with formoterol) / QVAR (beclomethasone — different)

Route: inhaled (DPI — Flexhaler) · inhaled (SVN) · nasal spray · oral (enteric-coated)
Onset: Hours to days (anti-inflammatory effect) — not for acute use
Duration: Sustained with regular use

Mechanism of action

Synthetic glucocorticoid. Binds intracellular glucocorticoid receptors → nuclear translocation → reduces transcription of inflammatory genes (cytokines, chemokines). Decreases airway eosinophilia, mast cell activity, and mucus production.

Dosing

Adult: Pulmicort Flexhaler DPI: 180–360 mcg BID (asthma). Max 720 mcg BID. SVN: 0.25–1 mg BID
Pediatric: SVN: 0.25–0.5 mg BID (12 months to 8 years). Flexhaler: 180 mcg BID (≥6 years)
Neonatal: Not typically used in neonates; racemic epinephrine preferred for croup in infants

Croup: 2 mg via SVN as single dose; may repeat in 12 hours

Indications

Asthma maintenance (all severity levels)
COPD (moderate-severe, adjunct to LABA/LAMA)
Croup (nebulized) — reduces subglottic edema
Eosinophilic esophagitis (swallowed formulation)

Contraindications

Acute bronchospasm (not a rescue drug)
Systemic fungal infections
Hypersensitivity to budesonide

Side effects

Oropharyngeal candidiasis (thrush)
Dysphonia (hoarseness)
Cough
Adrenal suppression (high doses, long term)
Growth retardation (children — high doses)
Osteoporosis (long term, high doses)

Monitoring parameters

Oral cavity for candidiasis
Growth velocity in children
HPA axis function with high doses
Bone density (long-term therapy)
Asthma control and exacerbation rate

Drug interactions

CYP3A4 inhibitors (ketoconazole, ritonavir) — increase budesonide levels
Additive adrenal suppression with systemic corticosteroids

All Drugs

Dosing

Adult

Pulmicort Flexhaler DPI: 180–360 mcg BID (asthma). Max 720 mcg BID. SVN: 0.25–1 mg BID

Pediatric

SVN: 0.25–0.5 mg BID (12 months to 8 years). Flexhaler: 180 mcg BID (≥6 years)

Neonatal

Not typically used in neonates; racemic epinephrine preferred for croup in infants

Croup: 2 mg via SVN as single dose; may repeat in 12 hours