Inhaled Corticosteroid
Pregnancy: Compatible with pregnancy; ICS recommended to maintain asthma control
Budesonide
Brand names: Pulmicort, Rhinocort, Symbicort (combination)
Adult dose
Dose: 200-800 micrograms/day inhaled
Route: Inhaled (MDI/DPI) / Nebulised
Frequency: Twice daily
Max: 1600 micrograms/day (severe asthma)
Croup: 2 mg nebulised single dose — evidence-based for moderate-to-severe croup
Paediatric dose
Dose: Fixed dose by age (inhaled); 2 mg for croup micrograms/day (inhaled)/kg
Route: Inhaled / Nebulised
Frequency: Twice daily (asthma); single dose (croup)
Max: 800 micrograms/day for most paediatric patients
Asthma prophylaxis: Child under 5 years: 100-200 micrograms twice daily. Child 5 years and over: 100-400 micrograms twice daily. Croup moderate-to-severe: 2 mg nebulised single dose (onset 30 min; reduces need for intubation). Use spacer device for MDI in children
Dose adjustments
Renal
No adjustment required
Hepatic
Increased systemic exposure in hepatic impairment; monitor for corticosteroid side effects
Paediatric weight-based calculator
Asthma prophylaxis: Child under 5 years: 100-200 micrograms twice daily. Child 5 years and over: 100-400 micrograms twice daily. Croup moderate-to-severe: 2 mg nebulised single dose (onset 30 min; reduces need for intubation). Use spacer device for MDI in children
Clinical pearls
- Nebulised budesonide 2 mg is NICE-recommended for moderate-to-severe croup as alternative to oral dexamethasone when oral route unavailable
- ICS linked to growth suppression in children — use minimum effective dose and monitor height annually
- Always advise spacer and rinse mouth after inhalation to prevent oral candidiasis
- Combination inhalers (Symbicort = budesonide + formoterol) not licensed under 6 years in most formulations
- High first-pass metabolism — lower systemic bioavailability than oral corticosteroids at equivalent inhaled doses
Contraindications
- Active pulmonary tuberculosis (untreated)
- Hypersensitivity to budesonide
Side effects
- Oropharyngeal candidiasis (rinse mouth after use)
- Dysphonia
- Adrenal suppression at high doses
- Cough
Interactions
- Ketoconazole / itraconazole (CYP3A4 inhibitors increase systemic budesonide exposure)
- Ritonavir (significant increase in plasma levels)
Monitoring
- Lung function (PEF/FEV1)
- Growth (height) annually
- Signs of adrenal suppression with high doses
Reference: BNF for Children; BTS/SIGN Asthma Guidelines; NICE CG187 (Croup). Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Drugs