Pulmicort (Budesonide) - Inhalation

What Is Pulmicort?

Pulmicort (budesonide) is an inhaled prescription medication used to prevent asthma symptoms. It comes in two formulations: Pulmicort Flexhaler and Pulmicort Respules.

The Pulmicort Flexhaler is an inhaler used to prevent asthma symptoms in adults and children 6 and older. Pulmicort Respules, on the other hand, are taken through a nebulizer, a machine that turns liquid into a mist breathed in through a mask over the mouth and nose. Pulmicort Respules are used to prevent asthma symptoms in children 12 months to 8 years old.

Pulmicort is an inhaled corticosteroid. It works by decreasing inflammation in the lungs, making it easier to breathe. Pulmicort does not treat acute asthma attacks or exacerbations.

Drug Facts

Generic Name: Budesonide

Brand Name(s): Pulmicort Flexhaler, Pulmicort Respules

Drug Availability: Prescription

Therapeutic Classification: Inhaled corticosteroid

Available Generically: Yes

Controlled Substance: N/A

Administration Route: Oral inhalation

Active Ingredient: Budesonide

Dosage Form(s): Inhaler, Respules for nebulizer

What Is Pulmicort Used For?

The Food and Drug Administration (FDA) approved:

  • Pulmicort Flexhaler (inhaler) to prevent asthma symptoms in adults and children 6 years and older
  • Pulmicort Respules for use in a nebulizer to prevent asthma symptoms in children 12 months to 8 years

Pulmicort is used to prevent symptoms only; it should not be taken for acute bronchospasm, or tightening of the airways. Instead, a fast-acting rescue inhaler should be used.

How to Take Pulmicort

If you are prescribed Pulmicort, read the prescription label and the information leaflet that comes with your prescription. Consult your healthcare provider if you have any questions. Ask them to show you how to use the inhaler or nebulizer.

Pulmicort is not a rescue medication for asthma attacks. An asthma attack requires a fast-acting rescue inhaler. Get medical help if your breathing problems are worsening, if you feel like your asthma medications are not working, or if your peak flow meter numbers are lower than usual.

The following are general tips for using Pulmicort:

  • When using the Flexhaler, use the inhaler device that comes with the Flexhaler. Do not take apart the Flexhaler or put it in water.
  • When using the Respules, only use a nebulizer. Do not mix Pulmicort with other medicines in the nebulizer. Shake the Respule gently before opening. Once opened, use it right away.
  • After using Pulmicort, rinse your mouth with water and spit. This helps prevent a fungal infection of the mouth or throat. If you are using the nebulizer, wash the area of the face where the mask was after each use.
  • Adults should help children use Pulmicort.

Call your healthcare provider any time you are sick, having surgery, or if you've recently had an asthma attack. They may need to change your dose. Never change your dose on your own. It is also a good idea to wear medical identification to alert emergency responders that you are taking steroid medication.

Storage

Store Pulmicort Flexhaler and Pulmicort Respules at room temperature (between 68 F and 77 F) with the cover tightly closed. Store away from light, heat, and moisture. Do not store it in the bathroom. Keep out of reach of children and pets.

Once an envelope of Respules has been opened, remove the one you'll be using and put the rest back into the package. Once opened, these Respules can be used for up to two weeks.

Off-Label Uses

When a medication is prescribed for indications that are not FDA-approved, it is called off-label use.

Pulmicort Respules may be used off-label to:

  • Treat children who have croup, which is an illness that causes difficulty breathing and a "barking" cough.
  • Prevent asthma symptoms in older children, adolescents, or adults
  • Prevent symptoms of chronic obstructive pulmonary disease in adults
  • Treat chronic sinus infections and nasal polyps, which are growths in the nasal cavities that cause inflammation and difficulty breathing from the nose. For this use, the Respules are placed in a machine called an atomizer, which helps deliver the medication to the areas of inflammation.
  • Treat eosinophilic esophagitis
  • Reduce wheezing symptoms in respiratory tract infections

The Pulmicort Flexhaler is also sometimes used off-label to prevent exercise-induced asthma.

How Long Does Pulmicort Take to Work?

You may notice an improvement in your symptoms in as little as 24 hours after the first dose. However, the full benefits may take one to two weeks. If no improvement is seen after this time, your healthcare provider may increase your dose.

For Pulmicort Respules, asthma control can be seen within two to eight days of starting treatment. It may take four to six weeks to achieve the maximum benefit.

What Are the Side Effects of Pulmicort?

This is not a complete list of side effects, and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your pharmacist or a healthcare provider. You may report side effects to the FDA at www.fda.gov/medwatch or 1-800-FDA-1088.

Like other medications, Pulmicort can cause side effects. Tell your healthcare provider about any side effects you experience while taking this medication.

Common Side Effects

The most common side effects of the Pulmicort Flexhaler include:

The most common side effects of Pulmicort Respules are:

  • Bloody nose
  • Cough
  • Ear infection
  • Fungal infection of the mouth or throat
  • Pink eye (conjunctivitis)
  • Rash
  • Symptoms of a respiratory infection, such as a stuffy nose
  • Gastrointestinal issues, such as stomach pain, vomiting, and diarrhea
  • Viral infections

Severe Side Effects

Contact your healthcare provider right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency.

Serious side effects and their symptoms can include the following:

  • Hypersensitivity reaction or anaphylaxis: Symptoms can include rash; hives; swelling around the lips, tongue, and face; and difficulty breathing. An allergic reaction may require emergency medical attention. 
  • Bronchospasm: This is when an unexpected, immediate increase in wheezing occurs after the medication is taken. If this occurs, use rescue medication should be used, stop Pulmicort, and contact your healthcare provider or get emergency medical help.
  • Eosinophilia and Churg-Strauss syndrome: This rare reaction may show symptoms of a rash, heart or lung symptoms, neuropathy (e.g., weakness, numbness, pain, and tingling), and high eosinophil counts (a type of white blood cell) in the blood work.

Long-Term Side Effects

Steroid use is associated with a variety of long-term side effects, although this is less likely with inhaled steroids than oral steroids. Long-term effects can include:

  • Adrenal suppression: Also known as Addison's disease, this condition may occur when the adrenal glands do not make enough hormones.
  • Hypercorticism: Also known as Cushing's syndrome, this condition may occur from an overproduction of cortisol.
  • Immunosuppression: This is when the body cannot fight disease and infection as well as it normally would.
  • Glaucoma: Certain eye conditions can cause blindness.
  • Cataracts: This causes clouding of the lens of the eye.
  • Osteoporosis: Weakening of the bones can lead to fractures.
  • Growth suppression in children: Children who take steroids will need to be monitored for growth.

Report Side Effects

Pulmicort may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your healthcare provider may send a report to the FDA's MedWatch Adverse Event Reporting Program or by phone (800-332-1088).

Dosage: How Much Pulmicort Should I Take?

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The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For preventing an asthma attack:
    • For inhalation dosage form (powder inhaler):
      • Adults and children 6 years of age and older—At first, one or two puffs two times a day. Your doctor may increase your dose as needed.
      • Children younger than 6 years of age—Use and dose must be determined by your doctor.
    • For inhalation dosage form (suspension in a nebulizer):
      • Children 12 months to 8 years of age—0.5 to 1 milligram (mg) in a nebulizer once a day, or divided and given twice a day. Each container of liquid has one dose and a new container is used for each dose.
      • Infants younger than 12 months of age—Use and dose must be determined by your doctor.

Modifications

The following groups of people may need to use caution when taking Pulmicort:

  • People 65 years and older, especially if other medical conditions are present
  • People with liver problems, regardless of their age

Pulmicort is considered safe to take while pregnant or breastfeeding. Budesonide has actually been regarded as the preferred first-line inhaled corticosteroid therapy for controlling asthma in pregnancy.

Before starting any new medications, always consult your healthcare provider if you are pregnant, plan to become pregnant, or are breastfeeding.

Missed Dose

If you miss a dose of Pulmicort, take it at the next regularly scheduled time. Do not use extra Pulmicort.

Overdose: What Happens If I Take Too Much Pulmicort?

Taking too much Pulmicort should not cause serious problems if you occasionally take an extra dose by accident. Taking too much Pulmicort over time, though, may cause some of the long-term side effects described above.

What Happens If I Overdose on Pulmicort?

If you think you or someone else may have overdosed on Pulmicort, call a healthcare provider or the Poison Control Center (800-222-1222).

If someone collapses or isn't breathing after taking Pulmicort, call 911 immediately.

Precautions

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It is very important that your doctor check you or your child's progress at regular visits. This will allow your doctor to see if the medicine is working properly and to check for any unwanted effects caused by this medicine.

You or your child should not use this medicine if your asthma attack has already started. Your doctor will prescribe another medicine (e.g., a short-acting inhaler) for you to use in case of an acute asthma attack. Call your doctor if you have any questions about this.

If your or your child's symptoms do not improve within one to two weeks, or if they become worse, check with your doctor.

This medicine may weaken your immune system. Avoid being around people who are sick or who have infections such as chickenpox or measles. Tell your doctor right away if you think you or your child have been exposed to chickenpox or measles.

If you or your child develop a skin rash, hives, or any type of allergic reaction (including anaphylaxis) to this medicine, stop using the medicine and check with your doctor as soon as possible.

This medicine may also increase your risk of having infections or sores in your mouth or throat. Check with your doctor right away if you or your child have any signs of a throat infection.

This medicine may decrease bone mineral density when used for a long time. A low bone mineral density can cause weak bones or osteoporosis. If you have any questions about this, talk to your doctor.

This medicine may cause children to grow more slowly than normal. This would cause a child to not gain weight or get taller. Talk with your child's doctor if you think this is a problem or if you have any concerns.

This medicine may increase your risk of having an adrenal gland that is less active than normal. The adrenal gland makes steroids for your body. This is more likely for people who use steroids for a long time or use high doses. Check with your doctor right away if you or your child have more than one of the following symptoms: darkening of the skin, diarrhea, dizziness, fainting, loss of appetite, depression, nausea, skin rash, unusual tiredness or weakness, or vomiting. Rarely, menstrual cycle changes, acne, pimples, or weight gain (fat deposits) around the face, neck, and trunk may occur while using this medicine.

Check with your doctor immediately if blurred vision, difficulty in reading, or any other change in vision occurs during or after treatment. Your doctor may want you or your child to have your eyes checked by an ophthalmologist (eye doctor).

Make sure any doctor or dentist knows that you or your child are using this medicine. You might need to stop using this medicine several days before having surgery.

Your doctor may want you or your child to carry a medical identification card that says this medicine is being used. You or your child may need additional medicine during an emergency, a severe asthma attack, an illness, or unusual stress.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

What Are Reasons I Shouldn't Take Pulmicort?

Before taking Pulmicort, tell your healthcare provider about your medical history and any medications you currently take, including over-the-counter (OTC) and prescription drugs.

Pulmicort may not be an appropriate option for everyone. For safety reasons, this medication you should not take this medication if you:

  • Are allergic to budesonide, any corticosteroids, or any of the inactive ingredients in Pulmicort
  • Have severe hypersensitivity to milk proteins (for Pulmicort Flexhaler)
  • Are having an acute asthma attack or bronchospasm
  • Are in status asthmaticus (a severe medical emergency that can happen when an asthma attack does not respond to treatment)

Pulmicort may be prescribed with caution in some people only if the healthcare provider determines it is safe. This includes those who:

  • Have liver problems
  • Have recently taken systemic steroids (such as oral steroids) for a long time
  • Are immunocompromised
  • Have an infection, including an active or latent tuberculosis infection
  • Were exposed to measles or chicken pox
  • Have osteoporosis or are at risk for osteoporosis
  • Have cataracts or glaucoma or are at risk for glaucoma
  • Have ocular herpes simplex infection (an eye infection caused by the herpes virus)

What Other Medications May Interact With Pulmicort?

Tell your healthcare provider about all the medicines you take, including prescription and OTC medications and vitamins or supplements.

While taking Pulmicort, do not start any new medications without approval from your healthcare provider. Pulmicort may interact with the following:

Consult your healthcare provider for a complete list of drug interactions, as others may occur.

What Medications Are Similar?

Pulmicort Flexhaler is an inhaler that contains the inhaled corticosteroid budesonide. Examples of other similar medications include:

  • Alvesco (ciclesonide)
  • Asmanex Twisthaler (mometasone)
  • Flovent HFA (fluticasone)
  • Qvar RediHaler (beclomethasone)

Other medications containing an inhaled corticosteroid are available that can be used for asthma or COPD in combination with other medications. Combination medications use two (or even three) medications that work in different ways to improve breathing. Examples include:

A type of drug called a long-acting beta-agonist or LABA (such as salmeterol, vilanterol, or formoterol) helps open up the lungs, allowing for easier breathing. However, a LABA should never be taken alone. Taking LABAs alone can increase the risk of death. They are always used with an inhaled steroid, usually in a combination product or as two separate prescriptions.

Additionally, there are various other drugs that may be prescribed for asthma or COPD maintenance, such as oral medications like Singulair (montelukast)Biologics, which are injected into the skin, are sometimes for difficult-to-control asthma.

This is a list of drugs also prescribed for asthma or COPD. It is NOT a list of drugs recommended to take with Pulmicort. Talk to your pharmacist or a healthcare provider if you have questions.

Frequently Asked Questions

  • What is Pulmicort used for?

    The Pulmicort Flexhaler inhaler contains budesonide. It prevents asthma symptoms in adults and children 6 years and older.

    Pulmicort Respules also contain budesonide but are for use in a nebulizer. Pulmicort Respules can be used to prevent asthma symptoms in children 12 months to 8 years old.

  • How does Pulmicort work?

    Pulmicort is an inhaled corticosteroid, or steroid. It works by decreasing swelling and inflammation in the lungs, making it easier to breathe. It must be used regularly to prevent asthma symptoms (maintenance treatment). Pulmicort does not treat asthma attacks.

  • What drugs interact with Pulmicort?

    Pulmicort may interact with certain antibiotics, antivirals, and antifungals. It also should not be taken with other steroids. Before taking Pulmicort, review your medication list with your healthcare provider.

  • How long does it take for Pulmicort to work?

    You may notice an improvement in symptoms in several days, but it may take up to a few weeks to see the full effect. Take Pulmicort every day as directed to see the most benefit. It is not an as-needed medicine.

  • What are the side effects of Pulmicort?

    Common side effects vary a bit based on whether you are using the Flexhaler or Respules. Some common side effects may include cold or allergy symptoms, such as a cough, stuffy nose, or a sore throat.

    Fungal infections of the mouth or throat may occur as well. You can prevent this by rinsing and spitting with water after every time you use Pulmicort. If you are using the Respules, you will also want to wash the area under where the mask was placed.

  • How do I stop taking Pulmicort?

    Steroids like Pulmicort should never be stopped abruptly. Doing so can affect your hormones. Your healthcare provider will tell you how long to take Pulmicort. If and when you stop taking Pulmicort, you will be provided with a tapering schedule to stop the drug slowly over time, which is a safer way to stop taking steroid medication.

How Can I Stay Healthy While Taking Pulmicort?

Before taking Pulmicort, discuss your medical history and all medication you take with your healthcare provider. When taking Pulmicort, follow your healthcare provider’s instructions for use. Read the patient information leaflet that comes with your prescription. You can also ask your healthcare provider to show you how to use the inhaler or nebulizer solution.

Pulmicort must be taken every day to help prevent and control asthma symptoms. Here are some tips for staying healthy while using your medication:

  • Rinse your mouth with water and spit it out after each use. This helps prevent a fungal infection of the mouth and throat. 
  • After using the Respules, wash your face under where the mask was placed.
  • While taking Pulmicort, avoid being near people who are sick. Call your healthcare provider immediately if you are exposed to measles or chicken pox.
  • Pulmicort cannot be used to treat an acute asthma attack. Instead, your healthcare provider will prescribe a rescue inhaler for this purpose. Bring your rescue inhaler with you wherever you go.

Contact your healthcare provider if you are using your rescue inhaler more frequently than usual or if you feel like it is not working as well as it used to.

Medical Disclaimer

Verywell Health's drug information is meant for educational purposes only and is not intended to replace medical advice, diagnosis, or treatment from a healthcare provider. Consult your healthcare provider before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.

8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Karen Berger, PharmD
Karen Berger, PharmD, is a community pharmacist and medical writer/reviewer.