Budesonide inhalers: steroid medicine used for asthma and COPD - NHS

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Budesonide inhalers - Brand name: Pulmicort

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  1. About budesonide inhalers
  2. Key facts
  3. Who can and cannot use budesonide inhalers
  4. How and when to use budesonide
  5. Side effects
  6. How to cope with side effects
  7. Pregnancy and breastfeeding
  8. Cautions with other medicines
  9. Common questions

1. About budesonide inhalers

Inhaled budesonide is a medicine used for asthma and chronic obstructive pulmonary disease (COPD).

You can take it 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.

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.

Budesonide inhalers and nebules are available on prescription only. Some inhalers contain budesonide mixed with other medicines that help your breathing (bronchodilators).

Budesonide is a type of medicine known as a steroid (also called a corticosteroid).

It also comes as nasal spray, tablets, capsules and granules, or rectal foam and enemas for treating other conditions. Read about:

  • budesonide nasal spray – for allergic rhinitis, hay fever and nasal polyps
  • budesonide tablets, capsules and granules – for inflammatory conditions such as Crohn's disease and ulcerative colitis, and autoimmune hepatitis
  • budesonide rectal foam and enemas – for ulcerative colitis

NHS coronavirus advice

If you have a steroid inhaler or nebuliser, carry on using it as usual. Use it even if you have coronavirus (COVID-19) symptoms.

It's important to use your inhaler or nebuliser to help control your asthma or COPD.

Updated: 6 April 2020

2. Key facts

  • Use your budesonide inhaler every day for it to work, even if you do not have any symptoms.
  • It's important to rinse your mouth or brush your teeth after using a steroid preventer inhaler. This is to prevent infections and a sore mouth.
  • You may get a blue steroid treatment card if you need a high dose of budesonide to control your symptoms.
  • You'll usually be given another inhaler, called a "reliever", to relieve your symptoms when they happen.
  • Do not change your brand of steroid inhaler without checking with your doctor first.
  • Budesonide sometimes comes mixed with formoterol. This type of inhaler is both a preventer and a reliever, and brand names include Symbicort Turbohaler, DuoResp Spiromax, Fobumix Easyhaler and AirBuFo Forspiro.

3. Who can and cannot use budesonide inhalers

Most adults can use budesonide inhalers and nebulisers.

Budesonide inhalers can be given to children aged 5 years and older. Inhalers containing budesonide and formoterol can be given to children aged 6 years and older.

Budesonide is not suitable for some people. To make sure it's safe for you, tell your doctor if you:

  • have had an allergic reaction to budesonide or any other medicines in the past
  • have ever had TB (tuberculosis)
  • are taking or have recently taken other steroid medicines
  • are being treated for viral or fungal infections
  • are pregnant or trying to get pregnant – your doctor may want to lower your dose

4. How and when to use budesonide

The usual dose for the inhaler is 1 or 2 puffs, once or twice a day. If you use your inhaler once a day, it may work better if you take it in the evening.

It's important to use your budesonide inhaler or nebuliser regularly to manage your symptoms. Use it regularly, even if you do not have any symptoms. After using your inhaler, always put the lid back on to keep it clean.

Budesonide inhalers come in different strengths. Your doctor, asthma or respiratory nurse will tell you which strength is right for you. Always follow their instructions. They 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.

How to use a nebuliser

Your doctor or nurse will give you clear instructions on how to use the nebuliser.

Nebulisers can give higher doses of budesonide than inhalers. They are sometimes used when inhalers (and other asthma medicines) are not working or if you cannot use inhalers.

The usual dose for the nebuliser is 1 or 2 nebules, breathed in from the nebuliser, twice a day. You will use it for 5 to 10 minutes each time.

Watch a video

 to help you manage your symptoms. You can search by type of inhaler and by brand (such as Pulmicort Turbohaler or DuoResp Spiromax).

If you use a pressurised metered-dose inhaler (pMDI), for example, you can watch the pMDI video.

Different types of inhalers

There are different types of budesonide inhaler. 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.

If your inhaler also contains formoterol (a bronchodilator) your doctor or asthma nurse might tell you to also use it when you are wheezy or tight chested. 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.

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.

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.

Will my dose go up or down?

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

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

What if I forget to use it?

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 as usual.

Do not take a double dose 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.

What if I take too much?

Taking too much budesonide by accident is unlikely to harm you.

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

Steroid cards

If you are using a steroid inhaler regularly, ask your doctor, nurse or a pharmacist if you need to carry a blue steroid card.

Important

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

5. Side effects

Like all medicines, budesonide can cause side effects although not everyone gets them.

With inhaled budesonide very little medicine gets into the rest of your body, so it's unlikely to give you side effects.

Common side effects

These common side effects may happen in more than 1 in 100 people.

Keep taking the medicine but talk to your doctor if these side effects bother you or do not go away:

  • oral thrush – a fungal infection that causes white patches, redness and soreness in your mouth
  • dry or sore throat, or hoarse voice

Serious side effects

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).

Tell a doctor straight away if you get:

  • a high temperature, chills, a very sore throat, ear or sinus pain, a cough, coughing up more mucus (phlegm) or 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
  • "moon face" (a puffy, rounded face), weight gain in the upper back or belly – this happens gradually and can be a sign of Cushing's syndrome
  • a very upset stomach or you're being sick (vomiting), very bad dizziness or passing out, muscle weakness, very tired, mood changes, loss of appetite and weight loss – these can be signs of adrenal gland problems
  • 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

It happens rarely but it is possible to have a serious allergic reaction (anaphylaxis) to budesonide.

This is different to an asthma attack. If you or your child have asthma symptoms, such as wheezing or have tightness in the chest or throat, use a reliever inhaler. If the symptoms do not improve or get worse, call 999 or go to A&E.

Immediate action required: Call 999 or go to A&E if:

  • you get a skin rash that may include itchy, red, swollen, blistered or peeling skin
  • you have trouble breathing or talking
  • your mouth, face, lips, tongue or throat start swelling

You could be having a serious allergic reaction and may need immediate treatment in hospital.

Children and teenagers

Taking budesonide at high doses for a long time can slow down the normal growth of children and teenagers.

Your child's doctor will monitor their height and weight carefully for as long as they're taking 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.

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

Information:

You can report any suspected side effect to the .

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

6. How to cope with side effects

What to do about:

  • oral thrush – make sure you are rinsing your mouth with water or brushing your teeth after using your inhaler to stop this happening. If you get oral thrush ask a pharmacist to recommend a suitable treatment such as a mouth gel and ask them to check that you're using your inhaler correctly. They may suggest that you see your doctor to discuss the best treatment.
  • dry or sore throat, or hoarse voice – make sure you're rinsing your mouth with water or brushing your teeth after using your inhaler to stop this happening.

7. Pregnancy and breastfeeding

Budesonide and pregnancy

It's important to manage your asthma or COPD while you're pregnant. Having uncontrolled breathing can be dangerous for you and your baby.

You can use a budesonide inhaler in pregnancy. There's no evidence that it will harm your baby.

Always tell your doctor if you're pregnant. For safety your doctor will only prescribe budesonide in pregnancy if the benefits outweigh the risks. They will prescribe the lowest dose that works for you.

If you become pregnant while taking budesonide, do not stop using your medicine without talking to your doctor first.

Find more information on on the Best Use of Medicines in Pregnancy (BUMPS) website.

Budesonide and breastfeeding

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

However, always check with your doctor first. Your baby may need extra monitoring if you use high doses of the inhaler.

Non-urgent advice: Tell your doctor if you're:

  • trying to get pregnant
  • pregnant
  • breastfeeding

8. Cautions with other medicines

Some medicines and budesonide interfere with each other. This can increase your chances of side effects, or it may mean changing your budesonide dose.

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

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

Mixing budesonide with herbal remedies and supplements

There's very little information about taking herbal remedies and supplements while taking or using budesonide. Ask a pharmacist for advice.

Important

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

9. Common questions

How does budesonide work?

Budesonide is a steroid (corticosteroid) medicine.

Steroids closely copy the effects of natural hormones produced in your adrenal glands. The adrenal glands are next to your kidneys.

Budesonide inhalers are called preventers. They work by calming down your immune system. This reduces the swelling in your lungs that makes it difficult to breathe. It also helps prevent you getting symptoms such as wheezing and coughing.

Budesonide on its own does not help treat an asthma attack when you suddenly get coughing, wheezing and breathlessness.

A budesonide inhaler containing formoterol may be used as both a preventer and a reliever (to relieve any symptoms when you get them).

Important

If you are coughing, wheezing or breathless, use your reliever inhaler.

How long does budesonide take to work?

A budesonide inhaler does not work straight away.

You'll usually start to wheeze less after using budesonide for 3 to 7 days.

Once your symptoms have improved, you may find you need to use your other inhaler (called a "reliever") less often.

If your shortness of breath or wheezing does not get better after 7 days of using budesonide, or if it gets worse, let your doctor or nurse know as soon as possible.

Is it safe to use budesonide for a long time?

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

Inhalers generally deliver a small amount of steroid medicine exactly where you need it. This limits the amount of steroid reaching the rest of your body. It also keeps the risk of side effects as low as possible.

However, for children and teenagers using a high-dose steroid inhaler, their height and weight needs to be monitored carefully. This is to make sure the steroid is not affecting their growth. Talk to their doctor if you're worried. They will be able to explain the benefits and risks of giving your child budesonide.

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.

What will happen if I stop using my budesonide inhaler?

Do not stop using your budesonide inhaler without speaking to your doctor 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.

Is there anything I need to know about taking budesonide and having surgery?

You do not need to stop budesonide before surgery. Suddenly stopping treatment can make you feel unwell and may give you symptoms.

If you are having surgery or having emergency treatment, for example after an accident, tell the person treating you that you are taking budesonide. Your doctor may decide you need extra steroids for a while.

If you have been given a blue steroid treatment card, show your card to anyone treating you so they can plan your treatment.

How does it compare with other preventer inhalers?

As well as budesonide inhalers, there are other "preventers" that contain steroids such as beclometasone, mometasone, fluticasone and ciclesonide.

They can look very different and some are for adults only.

It's important to use your own budesonide inhaler. Your inhaler may be different to a friend's or relative's. Their inhaler might contain a different dose of budesonide.

Preventer inhalers are different from the inhalers used during asthma attacks. These are called bronchodilators or "reliever" inhalers.

How do combination inhalers work?

Some inhalers contain budesonide combined with formoterol.

Formoterol is a type of medicine called a bronchodilator and is similar to salbutamol. Bronchodilators (also known as "relievers") work by relaxing the muscles of the airways into the lungs. This makes it easier to breathe.

Budesonide inhalers mixed with formoterol can be used as both a preventer and a reliever (to relieve any symptoms when you get them). This means you may use it more often.

Your doctor may tell you to use it every day as a preventer and also during an asthma attack as a reliever. Always follow the instructions from your doctor.

Will it affect my fertility?

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

However, speak to a pharmacist or your doctor if you're trying to get pregnant.

Will it affect my contraception?

Budesonide does not affect any type of contraception, including the combined pill and emergency contraception.

Can I drink alcohol with it?

Yes, you can drink alcohol while taking budesonide.

Can I smoke if I use a budesonide inhaler?

Try not to smoke. Smoking irritates the lungs and will make your breathing problem worse.

Budesonide will also work better if you do not smoke.

Speak to your doctor, nurse or pharmacist if you're finding it hard to stop smoking. Stop smoking treatments are available on the NHS.

Can I drive or ride a bike?

For most people, using a budesonide inhaler will not affect their ability to drive a car or cycle.

However, if your eyesight is affected in any way, do not drive or cycle.

Can lifestyle changes help with asthma or COPD?

There are several things you can do to help your condition when you're living with asthma or living with COPD. These include:

  • stopping smoking – not smoking can significantly reduce how severe and frequent your symptoms are
  • exercising regularly – exercise is unlikely to trigger your symptoms once you're on appropriate treatment
  • eating healthily – aim for a healthy, balanced diet and lose excess weight if you need to
  • getting vaccinated – it's a good idea to have the annual flu jab and the pneumococcal vaccination

Some people say that using an air filter or air purifier helps with their asthma symptoms. However, there needs to be more research into this.

Useful resources

Page last reviewed: 4 June 2020
Next review due: 4 June 2023