Inhaled Glucocorticoid·Respiratory - Asthma & COPD

Budesonide

Asthma maintenance, COPD maintenance (in severe cases with frequent exacerbations)

PBSSTEROIDPulmicort, Symbicort (combo)S4TGA

No source link confirmed for this record yet. Its own source notes are under Additional.

At a glance

Max Dose

800 mcg/day

Half-life

2-3 h

Caution: Thrush

HIGH RISK

Wash Mouth

MANDATORY

Cautions

Avoid / Cautions

Status asthmaticus (does not provide acute relief). Pregnancy Category A. Widely studied and highly safe in pregnancy.

Where it stands

Rapid Summary

Overview

Inhaled Corticosteroid (ICS). The cornerstone of asthma prevention and chronic inflammation control in the airways.

Clinical Focus

Must rinse and spit after every use to prevent severe oropharyngeal candidiasis (oral thrush).

Bottom Line

Budesonide is a first-line inhaled corticosteroid for asthma and COPD with good local potency, but oral candidiasis requires mouth rinsing after every dose.

Formulation & Access

Brand Names

Pulmicort, Symbicort (combo)

Oral Routes

Dry powder inhaler (Turbuhaler 100 mcg, 200 mcg, 400 mcg). Nebules (1 mg/2 mL).

Prescribing & PBS

Unrestricted General Benefit (S4).

Indications & Use

Primary

PBSTGA

Asthma maintenance, COPD maintenance (in severe cases with frequent exacerbations).

Off-Label

OFF

Eosinophilic esophagitis, Croup.

Clinical Place

First-line preventative therapy for any patient requiring a SABA more than twice a month.

Quick reference

Class & Role

Inhaled Glucocorticoid — Inhaled Corticosteroid (ICS).

Route / Formulation

Dry powder inhaler (Turbuhaler 100 mcg, 200 mcg, 400 mcg). Nebules (1 mg/2 mL). (Pulmicort, Symbicort (combo))

Usual Dose & Max

Inhaled 100-400 mcg BD. (Often combined with formoterol as Symbicort). Max 800 mcg/day (Doses > 800 mcg/day provide little extra local benefit but drastically increase systemic absorption/side effects).

Key Indication Doses

Asthma Maintenance: Inhaled 100-400 mcg BD. (Often combined with formoterol as Symbicort). Croup (Paediatrics): Inhaled 2 mg via nebuliser STAT. Eosinophilic Esophagitis: PO (Off-label) Slurry made from respules, swallowed.

Best Uses

Budesonide is a first-line inhaled corticosteroid for asthma and COPD with good local potency, but oral candidiasis requires mouth rinsing after every dose.

Key Risks

Oral/Pharyngeal: Oropharyngeal candidiasis (thrush), dysphonia (hoarse voice). Endocrine: At high doses (>800 mcg/day), systemic absorption can cause adrenal suppression, reduced bone mineral density, and skin thinning. Ocular: Increased risk of cataracts/glaucoma with long-term high-dose use.

Key Interactions

Strong CYP3A4 inhibitors (Itraconazole, Ritonavir) can drastically increase systemic budesonide levels, leading to Cushing's syndrome and adrenal suppression.

Monitoring

Inspect oral cavity for white plaques (thrush). Check inhaler technique. No specific routine laboratory tests required for standard doses.

Clinical Pearl

The vast majority of an ICS puff hits the back of the throat. Rinsing the mouth and spitting out the water washes away the drug, preventing thrush and preventing it from being swallowed into the systemic circulation.

Access

Pulmicort, Symbicort (combo)

Brand: Pulmicort, Symbicort (combo)
Formulation: Dry powder inhaler (Turbuhaler 100 mcg, 200 mcg, 400 mcg). Nebules (1 mg/2 mL).

From this page

No calculator, monitoring schedule or factsheet is linked to this medicine page yet.

Inhaled Glucocorticoid·Respiratory - Asthma & COPD

Budesonide

Asthma maintenance, COPD maintenance (in severe cases with frequent exacerbations)

PBSSTEROIDPulmicort, Symbicort (combo)S4TGA

No source link confirmed for this record yet. Its own source notes are under Additional.

At a glance

Max Dose

800 mcg/day

Half-life

2-3 h

Caution: Thrush

HIGH RISK

Wash Mouth

MANDATORY

Cautions

Avoid / Cautions

Status asthmaticus (does not provide acute relief). Pregnancy Category A. Widely studied and highly safe in pregnancy.

Where it stands

Rapid Summary

Overview

Inhaled Corticosteroid (ICS). The cornerstone of asthma prevention and chronic inflammation control in the airways.

Clinical Focus

Must rinse and spit after every use to prevent severe oropharyngeal candidiasis (oral thrush).

Bottom Line

Budesonide is a first-line inhaled corticosteroid for asthma and COPD with good local potency, but oral candidiasis requires mouth rinsing after every dose.

Formulation & Access

Brand Names

Pulmicort, Symbicort (combo)

Oral Routes

Dry powder inhaler (Turbuhaler 100 mcg, 200 mcg, 400 mcg). Nebules (1 mg/2 mL).

Prescribing & PBS

Unrestricted General Benefit (S4).

Indications & Use

Primary

PBSTGA

Asthma maintenance, COPD maintenance (in severe cases with frequent exacerbations).

Off-Label

OFF

Eosinophilic esophagitis, Croup.

Clinical Place

First-line preventative therapy for any patient requiring a SABA more than twice a month.

Quick reference

Class & Role

Inhaled Glucocorticoid — Inhaled Corticosteroid (ICS).

Route / Formulation

Dry powder inhaler (Turbuhaler 100 mcg, 200 mcg, 400 mcg). Nebules (1 mg/2 mL). (Pulmicort, Symbicort (combo))

Usual Dose & Max

Key Indication Doses

Best Uses

Budesonide is a first-line inhaled corticosteroid for asthma and COPD with good local potency, but oral candidiasis requires mouth rinsing after every dose.

Key Risks

Key Interactions

Strong CYP3A4 inhibitors (Itraconazole, Ritonavir) can drastically increase systemic budesonide levels, leading to Cushing's syndrome and adrenal suppression.

Monitoring

Inspect oral cavity for white plaques (thrush). Check inhaler technique. No specific routine laboratory tests required for standard doses.

Clinical Pearl

Access

Pulmicort, Symbicort (combo)

Brand: Pulmicort, Symbicort (combo)
Formulation: Dry powder inhaler (Turbuhaler 100 mcg, 200 mcg, 400 mcg). Nebules (1 mg/2 mL).

From this page

No calculator, monitoring schedule or factsheet is linked to this medicine page yet.