Inhaled Corticosteroid Pregnancy: Most prospective epidemiological and post-marketing data have not detected an increased risk to the foetus/newborn from inhaled budesonide during pregnancy; review therapy regularly and maintain at the lowest effective dose. Inhaled glucocorticosteroids are preferred to oral. Can be used during breast-feeding (excreted in breast milk but negligible systemic exposure to the infant at therapeutic doses).

Budesonide

Brand names: Pulmicort, Rhinocort, Symbicort (combination)

Budesonide is a corticosteroid used in children in inhaled form for asthma prophylaxis, nebulised for croup, and in oral or rectal forms for inflammatory bowel disease, depending on the preparation.

Adult dose

Dose: Bronchial asthma, children 3 months to 12 years (nebuliser suspension) — initiation of therapy: 0.5-1 mg twice daily; maintenance: 0.25-0.5 mg twice daily. Children 12 years and older: dosage as for adults.

Route: Inhalation via jet nebuliser (with mouthpiece or suitable face mask; children use under adult supervision)

Frequency: Twice daily; individualise to the lowest dose that keeps the child symptom-free

Max: Highest dose 2 mg per day for children under 12 years — only in severe asthma and for limited periods

Source SPC is Budesonide 0.5 mg nebuliser suspension; this draft is framed for the paediatric context but posology is the same product. Bronchial asthma: children 3 months to 12 years — initiation 0.5-1 mg twice daily, maintenance 0.25-0.5 mg twice daily; children 12 years and older dosed as adults (initiation usually 1-2 mg twice daily, maintenance 0.5-1 mg twice daily). CROUP (infants and children): usual dose 2 mg nebulised budesonide, given as a single administration OR as two 1 mg doses separated by 30 minutes; dosing can be repeated every 12 hours for a maximum of 36 hours or until clinical improvement. Doses are fixed by age/indication and are NOT expressed per-kg. Ultrasonic nebulisers are not suitable. Can be mixed with 0.9% saline and with terbutaline, salbutamol, fenoterol, acetylcysteine, sodium cromoglycate or ipratropium nebuliser solutions (use admixture within 30 minutes). Advise mouth rinsing with water after inhaling to reduce oropharyngeal candidiasis; wash the child's facial skin after face-mask use. Monitor growth in children due to the risk of growth retardation. Verify paediatric dosing against a children's formulary. NB the openFDA (US) label captured is a different product — an OTC intranasal spray for allergic rhinitis (children 6 to <12: 1 spray per nostril once daily; children under 6: do not use) — do not conflate with the UK nebuliser posology.

Dose independently re-sourced from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — clinician-reviewed. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to the active substance or to any excipient

Side effects

Oropharyngeal candidiasis (common)
Cough, hoarseness, throat irritation (common)
Behavioural changes predominantly in children — psychomotor hyperactivity, sleep disorders, aggression (rare)
Growth retardation / signs of systemic corticosteroid effects including adrenal suppression (rare)
Cataract, blurred vision (uncommon); tremor (uncommon)
Paradoxical bronchospasm (rare); hypersensitivity reactions including rash, urticaria, angioedema (rare)

Clinical monograph

How it works

It binds glucocorticoid receptors to suppress inflammatory gene expression and cytokine production, reducing airway or mucosal inflammation locally with relatively limited systemic exposure.

Prescribing in practice

Inhaled corticosteroids can suppress growth velocity and the adrenal axis in children, so use the lowest effective dose and monitor height regularly.
Rinsing the mouth after inhaled doses reduces oral candidiasis and hoarseness, and the formulation chosen must match the indication.
High or prolonged dosing increases the risk of systemic corticosteroid effects.

Monitoring

Monitor growth, asthma control or disease activity, and inspect for oral thrush with inhaled use.

Counselling the patient

Use the inhaled preparation regularly for prevention, not for sudden symptom relief.
Rinse the mouth and spit out after each inhaled dose.
Attend reviews so the child's growth and dose can be checked.

Evidence & guidelines

Inhaled budesonide is a recommended preventer in paediatric asthma guidance, with monitoring for growth and adrenal effects.

Reference: BTS/SIGN Asthma Guidelines; NICE CG187 (Croup); Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

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