Pulmicort

Pulmicort is an inhaled corticosteroid (ICS) that contains the active ingredient budesonide. It forms the basis of long-term asthma therapy.

Unlike bronchodilators, Pulmicort does not relieve acute shortness of breath; instead, it works preventively: it reduces the chronic inflammation in the airways and thereby prevents asthma attacks. The effect builds up over days to weeks.

Pulmicort is available as a Turbuhaler, as a metered-dose inhaler and as a suspension for nebulizers.

Budesonide has an anti-inflammatory effect in the airways:

Mechanism of action: 1. Budesonide enters the cells of the airways 2. Binds to glucocorticoid receptors 3. Activates anti-inflammatory genes 4. Inhibits the production of inflammatory mediators

Effects:

• Reduces swelling of the bronchial mucosa
• Decreases mucus production
• Lowers airway hyperresponsiveness
• Prevents structural changes (remodeling)

Time course:

• First effects after a few days
• Full effect after 1-2 weeks of regular use
• No immediate effect in acute shortness of breath!

Pulmicort is suitable for:

• All severity levels of asthma (as maintenance therapy)
• Children aged 5 years and older (Turbuhaler)
• Young children (suspension for nebulizers)
• COPD (in combination with other medications)

Areas of use:

• Mild persistent asthma (alone)
• Moderate/severe asthma (often combined with a LABA)
• Step-by-step adjustment of therapy

Not suitable for:

• Acute asthma attacks (does not work immediately)
• Sole therapy in severe asthma

Pulmicort Turbuhaler:

• 100 µg per dose (for children)
• 200 µg per dose
• 400 µg per dose

Pulmicort metered-dose inhaler:

• 50 µg per puff
• 200 µg per puff

Dosage for asthma (adults):

• Mild: 200-400 µg daily
• Moderate: 400-800 µg daily
• Severe: 800-1600 µg daily

For children:

• Lower doses depending on age and severity

Turbuhaler: 1. Unscrew the protective cap 2. Hold upright, turn the grip to the right and back (click) 3. Breathe out deeply (not into the inhaler) 4. Close your lips around the mouthpiece, breathe in forcefully 5. Hold your breath for 10 seconds 6. Rinse your mouth, spit out

Metered-dose inhaler:

• With coordination or, better, with a spacer
• Rinse your mouth after inhalation

Important:

• Use regularly, even when you have no symptoms
• Do not stop abruptly
• Always rinse your mouth (to prevent oral thrush)
• The effect takes time – be patient!

Do not use in case of:

• Hypersensitivity to budesonide

Caution in case of:

• Active pulmonary tuberculosis
• Fungal, viral or bacterial respiratory infections
• Severe liver impairment (delayed breakdown)

Pregnancy: Can and should be used for asthma. Uncontrolled asthma is more dangerous than inhaled budesonide.

Breastfeeding: Passes into breast milk in small amounts. Use is possible.

Common (1-10%):

• Oral thrush (candidiasis)
• Hoarseness
• Irritation of the throat
• Cough after inhalation

Uncommon:

• Headache
• Taste disturbances
• Nausea
• Cataract

Rare (with high doses/long-term therapy):

• Systemic corticosteroid effects
• Adrenal suppression
• Slowed growth in children
• Skin changes (bruising)
• Osteoporosis

Frequency not known:

• Glaucoma

Prevention:

• Rinse your mouth after inhalation
• Use the lowest possible effective dose

Interactions:

• CYP3A4 inhibitors (ketoconazole, itraconazole, ritonavir) – increased budesonide levels
• Estrogens – may enhance the effects of budesonide

No relevant interaction with:

• Bronchodilators (a useful combination)
• Most other medications

Note: When strong CYP3A4 inhibitors are taken at the same time, systemic corticosteroid effects may occur.