Inhaled Corticosteroid (ICS) Pregnancy: Compatible — preferred ICS in pregnancy due to largest evidence base

Budesonide (Inhaled)

Brand names: Pulmicort, Symbicort component

Adult dose

Dose: 200–400 mcg BD (moderate), up to 800 mcg BD (severe asthma). COPD: 400 mcg BD

Route: Inhaled

Frequency: Twice daily

Max: 1600 mcg/day

Lower systemic bioavailability than fluticasone. Nebulised budesonide 0.5–2 mg BD for acute severe asthma (alternative to systemic steroids in some protocols).

Paediatric dose

Route: Inhaled (nebulised or MDI)

Frequency: BD

Max: 400 mcg BD

Concentration: 0.5 mg/2 mL or 1 mg/2 mL nebuliser suspension mcg per dose/ml

Children ≥6 months: 0.5–1 mg BD nebulised. NICE: step-up to ICS when SABA needed >2 days/week.

Dose adjustments

Renal

No dose adjustment

Hepatic

Caution in severe hepatic impairment

Clinical pearls

Rinse mouth and gargle after each dose
In asthma, budesonide-formoterol (Symbicort) enables SMART therapy — same inhaler for maintenance and rescue
GINA 2019+: budesonide-formoterol preferred reliever over SABA-only for safety reasons
Nebulised budesonide (1 mg TDS) is an alternative to IV hydrocortisone in moderate acute asthma in selected patients

Contraindications

Active untreated TB (relative)
Hypersensitivity to budesonide

Side effects

Oral candidiasis
Dysphonia/hoarseness
HPA axis suppression (high doses)
Growth suppression in children (high doses)
Paradoxical bronchospasm

Interactions

Strong CYP3A4 inhibitors — increased budesonide exposure
Systemic corticosteroids — additive adrenal suppression risk

Monitoring

Spirometry/peak flow
Oral candidiasis
Growth monitoring in children
Adrenal function (prolonged high-dose use)

Reference: BNFc; BNF; GINA 2024; BNF for Children. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Beclometasone Dipropionate Inhaler · Inhaled Corticosteroid (ICS)

Pathways