Pulmicort for Asthma

Pulmicort Flexhaler is an effective inhaled steroid for the treatment of asthma. © Daniel More, MD

Pulmicort (budesonide) is an inhaled steroid used for the maintenance treatment of asthma and can be quite effective. Pulmicort treats the inflammation that exists in the lungs of many people with asthma, which results in fewer asthma symptoms over time. Unlike albuterol inhalers, which treat the airway constriction that causes the immediate symptoms of asthma, Pulmicort is taken on a daily basis to prevent the symptoms of asthma.

Available Formulations of Pulmicort

Pulmicort is available in two formulations, as a dry powder Flexhaler and as a Respule solution for nebulizers. The Flexhaler version is available in 2 dosages, 90 micrograms per puff and 180 micrograms per puff for adults and children 6 years and older. The recommended dose for children 6 to 17 years of age is 180 to 360 micrograms twice a day, and 180 micrograms to 720 micrograms twice daily for adults. Pulmicort Respules are delivered via a nebulizer (these are not taken by mouth) and are indicated for children 1 to 8 years of age. Respules are available in 3 strengths, 0.25 milligram, 0.5 milligram, and 1 milligram. Recommended dosages range from 0.25 milligrams twice daily to 1 milligram once daily.

How Pulmicort Compares to Other Inhaled Steroids

There are many brands of inhaled steroids available to treat the underlying inflammation of asthma, and these medications all work about the same.

Pulmicort has the advantage of being the only inhaled steroid with a pregnancy category ‘B’ rating. Pregnancy category ratings of medications refer to safety during pregnancy, and although there is no asthma medication that is considered completely safe during pregnancy, category ‘B’ medications are the safest ones available.

All other inhaled steroids have a pregnancy category ‘C’ rating, which is less favorable. Pulmicort Respules has the advantage of being the only inhaled steroid available in nebulizer form, which may allow for better delivery of the medication to the lungs of young children who have difficulty using an inhaler. In addition, Pulmicort Respules are available in a generic form, which usually means the non-branded version is available at a lower cost.

Find out more about the use of asthma medications during pregnancy.

Pulmicort Flexhaler and Milk Allergy

According to the package insert, Pulmicort Flexhaler contains lactose powder "which contains trace levels of milk proteins” -– and therefore should not be used by people with milk allergy. The package insert states that there have been reports of anaphylaxis occurring in people with milk allergy using Pulmicort Flexhaler, but I could not find specific information on these cases. While pharmaceutical-grade lactose is derived from milk and typically does not contain milk proteins, there is the possibility that the lactose does contain small amounts of milk protein, and therefore should not be used by people with milk allergy. Pulmicort Respules do not contain lactose or milk protein, and therefore can be used in children with milk allergy.


Expert Panel Report 3 (EPR3): Guidelines for the Diagnosis and Management of Asthma

Nowak-Wegrzyn A, et al. Contamination of Dry Powder Inhalers for Asthma with Milk Proteins Containing Lactose. J Allergy Clin Immunol. 2004;113:558-60.

Pulmicort Flexhaler Package Insert. Astra-Zenica Corporation. 

Pulmicort Respules Package Insert. Astra-Zenica Corporation.