Medicines

Budesonide inhaler for asthma prevention

This leaflet is for parents and carers about how to use this medicine in children. Our information may differ from that provided by the manufacturers, because their information usually relates to adults. Read this leaflet carefully. Keep it somewhere safe so that you can read it again.

budesonide inhalers should not be used during an acute asthma attack (sudden onset of wheezing and breathlessness). Use your child’s reliever medicine (usually a blue salbutamol inhaler).

Name of medicine

Budesonide

Brand names: These include Easyhaler® Budesonide, Budesonide Cyclocaps®, Budelin Novolizer®, Turbohaler® and Pulmicort®.

This leaflet is about the use of inhaled budesonide for asthma. It is taken regularly in order to prevent attacks. (This is sometimes called asthma prophylaxis.)

Why is it important for my child to take budesonide?

Budesonide is a steroid medicine. It reduces inflammation in the lungs that can act as a trigger for an asthma attack, and so should reduce the number of attacks. Budesonide is commonly called a ‘preventer’ medicine. It is important that your child takes it regularly to help prevent asthma attacks. 

budesonide will not reduce wheezing or breathlessness during an acute asthma attack – your child should use their ‘reliever’ inhaler for this (this is often a blue salbutamol inhaler).

What is budesonide available as?

Budesonide has to be inhaled into the lungs (breathed in) to work. A special device called an inhaler is used and this is usually used with another device called a spacer. Dry powder inhalers are sometimes used for older children.

Metered dose inhalers: 100, 200 and 400 micrograms per inhalation

  • Easyhaler® Budesonide
  • Budesonide Cyclocaps® 
  • Budelin Novolizer®
  • Turbohaler®
  • Pulmicort®

Your doctor may suggest that your child uses an inhaler that provides budesonide together with another medicine called formoterol, which has the brand name Symbicort® and uses a Turbohaler®. 

When should I give budesonide

Budesonide is usually given twice each day, once in the morning and once in the evening. Ideally, these times are 10–12 hours apart, for example some time between 7 and 8 am, and between 7 and 8 pm.

Sometimes it is just used once a day: this can be in the morning or the evening.

Give the medicine at about the same time(s) each day so that this becomes part of your child’s daily routine, which will help you to remember. 

How much should I give?

Your doctor will work out the amount of budesonide (the dose) that is right for your child. The dose will be shown on the medicine label.

It is important that you follow your doctor’s instructions about how much to give.

How should I give budesonide?

Using an aerosol inhaler with a ‘spacer’ device

Your doctor or asthma nurse will show you how to use the aerosol inhaler and spacer device, if one is needed. An instruction leaflet will also be provided with the inhaler. This will tell you how to put the inhaler together and how to use it.

  • Put the spacer device together, following the instructions that come with it. Attach the mask to the spacer mouth piece.
  • For a young child, attach the mask to the spacer mouth piece. If your child can hold the spacer mouth piece in their mouth and hold it firmly between their lips, creating a good seal, you may not need to use the mask.
  • Take the cap off the inhaler, making sure that the mouth piece is clean.
  • While holding the inhaler upright, place your thumb on the bottom of the inhaler and your first finger on the top. Then shake the inhaler several times up and down.
  • If the inhaler is new or has not been used for three days or more, one puff should be released into the air.
  • Insert the mouth piece of the inhaler into the spacer. It should fit easily and securely.
  • Place the mask over your child’s mouth and nose, ensuring a good seal with the skin around the mouth. Reassure your child during this step, as they may be distressed.
  • Press down once on the aerosol canister with the first finger. This releases one puff into the spacer.
  • Hold the mask in place and encourage your child to take five deep and slow breaths in and out. It is important not to rush this step.
  • If more than one dose/puff is required, wait for one minute then repeat the previous steps.
  • Your child should rinse their mouth out thoroughly with water or clean their teeth after use.

Using a dry-powder inhaler

There are many different types of dry-powder inhaler. These are not used with a spacer.

Follow the instructions that come with your inhaler for how to get it ready. If you are not sure how to do this, ask your pharmacist or nurse to show you. The following instructions are for most dry-powder inhalers:

  • Ask your child to breathe out normally, as far as they can. Place the mouthpiece of the inhaler firmly between the lips, ensuring a good seal around the mouthpiece.
  • Once they have started to breathe in, give (release) the dose as directed by your pharmacist or nurse. Your child should continue to finish the breath in, so that they inhale the puff of medicine.
  • Take the inhaler out of your child’s mouth. They should close their mouth and hold their breath for 5–10 seconds, or for as long as they can comfortably manage. They can then breathe normally. It is important not to rush this step.
  • If your child has to take more than one puff, they should breathe normally for a minute or so before giving the next one.
  • Your child should rinse their mouth out thoroughly with water or clean their teeth after use.

Using a Turbohaler

Follow the instructions that come with your turbohaler for how to get it ready. If you are not sure how to do this, ask your pharmacist or nurse to show you.

  • Hold the inhaler upright with the grip downwards, and the opening upwards. Turn the inhaler all the way in one direction until it clicks, then turn it back completely in the other direction. The click means it is ready to use.
  • Ask your child to breathe out normally, as far as they can. Place the mouthpiece of the inhaler firmly between the lips, ensuring a good seal around the mouthpiece.
  • Then ask your child to breathe in forcefully through the mouthpiece.
  • Take the inhaler out of your child’s mouth. They should close their mouth and hold their breath for 5–10 seconds, or for as long as they can comfortably manage. They can then breathe normally. It is important not to rush this step.
  • If your child has to take more than one puff, they should breathe normally for a minute or so before giving the next one.
  • Your child should rinse their mouth out thoroughly with water or clean their teeth.

If you are not sure whether you are using the inhaler properly, or need help, contact your asthma nurse or pharmacist, who will be able to show you or check what you are doing.

When should the medicine start working?

Budesonide needs to be given regularly to prevent asthma and wheeze. It will start to work within 24 hours, but it may take a few weeks to reduce the inflammation. Your child may continue to have attacks during this time, but they should start to happen less often. Continue to give the medicine as told to by your doctor or nurse, even if your child does not have any wheeze or other symptoms of asthma.

If your child’s asthma does not seem to be getting any better after 6 weeks, and they still need to use their reliever medicine often, contact your doctor or nurse. 

What if my child is sick (vomits)?

If your child is sick at any time, you do not need to give them another dose, as inhaled medicine will still work.

What if I forget to give it?

If you remember up to 6 hours after you should have given a dose, give your child the missed dose. For example, if you usually give a dose at about 7 am, you can give the missed dose at any time up to 1 pm. If you remember after that time, do not give the missed dose. Wait until the next normal dose.

What if I give too much?

Budesonide is unlikely to cause any harm if your child accidentally has more puffs than your doctor has recommended, but if your child takes too much inhaler on several occasions, there may be side-effects.

If you are worried that you may have given your child too much budesonide, contact your doctor or local NHS services (call 111 in England and Scotland; 111 or 0845 4647 in parts of Wales). Have the inhaler or packaging with you if you telephone for advice.

Are there any possible side effects?

We use medicines to make our children better, but sometimes they have other effects that we don’t want (side effects).

Side effects you must do something about

If your child is taking a high dose of budesonide, they may develop a yeast infection in the mouth, called oral thrush. If you notice a thick white or cream-coloured covering on your child’s tongue, or the mouth is red and irritated, contact your doctor for advice, as this may need treatment. You can help prevent this by making sure that your child rinses their mouth with water after using budesonide.

Other side-effects you need to know about

  • If your child’s voice is hoarse or their throat is sore after using the inhaler, encourage them to rinse their mouth after every use.

  • Your child may have a dry mouth. Eating citrus fruits (e.g. oranges) and sipping water may help.

  • The budesonide may slow the speed at which your child grows at the start of treatment, but they will probably catch up when their asthma is properly controlled. Their final adult height should not be affected. Your doctor should monitor the growth of your child while they are receiving treatment with budesonide.

  • All steroid medicines, including budesonide, but only in high doses, may affect the adrenal glands so that they produce less of a hormone called cortisol when the body is stressed (e.g. during illness or injury). This means that your child may have more difficulty fighting off an infection, or may recover less quickly from injury or after surgery.

There may sometimes be other side effects that are not listed above. If you notice anything unusual and are concerned, contact your doctor. You can report any suspected side effects to a UK safety scheme at www.mhra.gov.uk/yellowcard

Can other medicines be given at the same time as budesonide?

  • You can give your child medicines that contain paracetamol or ibuprofen, unless your doctor has told you not to.

budesonide should not be taken with some medicines that you get on prescription. It is important to tell your doctor and pharmacist about any other medicines your child is taking before starting budesonide.

  • Check with your doctor or pharmacist before giving any other medicines to your child. This includes herbal and complementary medicines.

Is there anything else I need to know about this medicine?

If your child becomes very unwell or requires an operation, tell the doctors that your child uses a budesonide inhaler.

In a very few cases, children become unwell when they stop or reduce the amount of any steroid medicine they are taking, including budesonide (in high doses). This may include your child becoming very tired or dizzy, having stomach pains or vomiting. If you are at all worried about this, contact your doctor straight away.

  • There are many different inhalers available. If your child is having difficulty with one of them, you can ask your doctor or pharmacist to change it for another one.
  • Even with regular use of budesonide, your child may still have asthma attacks. Use a reliever medicine as usual for these.

General advice about medicines

  • Try to give medicines at about the same times each day, to help you remember.
  • If you are not sure a medicine is working, contact your doctor but continue to give the medicine as usual in the meantime. Do not give extra doses, as you may do harm.
  • Only give this medicine to your child. Never give it to anyone else, even if their condition appears to be the same, as this could do harm.
  • Make sure that you always have enough medicine. Order a new prescription at least 2 weeks before you will run out.
  • Make sure that the medicines you have at home have not reached the ‘best before’ or ‘use by’ date on the packaging. Give old medicines to your pharmacist to dispose of.

If you think someone else may have taken the medicine by accident, contact your doctor straight away.

Where should I keep this medicine?

  • Keep the medicine in a cupboard, away from heat and direct sunlight.
  • It does not need to be kept in the fridge.
  • Make sure that children cannot see or reach the medicine.
  • Keep the medicine in the container it came in.

Who to contact for more information?

Your doctor, pharmacist or nurse will be able to give you more information about budesonide and about other medicines used to treat asthma.

England: NHS 111

Tel 111

www.nhs.uk

Scotland: NHS 24

Northern Ireland: NI Direct

Wales: NHS Direct

Tel 111 (free) or 0845 46 47 (2p per minute)

111.wales.nhs.uk/

Asthma UK

0300 222 5800

www.asthma.org.uk/

Copyright disclaimer

Version [1]. © NPPG, RCPCH and WellChild, all rights reserved. Review by May 2015.

The primary source for the information in this leaflet is the British National Formulary for Children. For details on any other sources used for this leaflet, please contact us through our website, www.medicinesforchildren.org.uk.

We take great care to make sure that the information in this leaflet is correct and up-to-date. However, medicines can be used in different ways for different patients. It is important that you ask the advice of your doctor or pharmacist if you are not sure about something. This leaflet is about the use of these medicines in the UK, and may not apply to other countries. The Royal College of Paediatrics and Child Health (RCPCH), the Neonatal and Paediatric Pharmacists Group (NPPG), WellChild and the contributors and editors cannot be held responsible for the accuracy of information, omissions of information, or any actions that may be taken as a consequence of reading this leaflet.