Pulmicort (Budesonide): Corticosteroid for Asthma & COPD

Pulmicort is a brand name for budesonide, an inhaled corticosteroid (ICS) used as maintenance therapy for chronic inflammatory airway diseases.

Indications

• Asthma: Persistent asthma (GINA steps 2–4); reduces exacerbations, improves control.
• COPD: In combination with LABA (e.g., budesonide/formoterol) for frequent exacerbators with elevated eosinophils.
• Eosinophilic esophagitis (off-label): Oral viscous budesonide slurry.

Formulations

• Flexhaler (DPI): 90, 180 mcg/inh.
• Respules (nebulizer): 0.25, 0.5, 1 mg/2 mL – for children/unable to use inhaler.
• Combination: Symbicort (budesonide/formoterol).

Mechanism

Binds glucocorticoid receptor → translocates to nucleus → upregulates anti-inflammatory proteins (annexin-1, IL-10), downregulates proinflammatory genes (cytokines, adhesion molecules, inflammatory enzymes).

Key Safety Points

• Local: oral thrush (rinse after use), dysphonia.
• Systemic (dose-dependent): adrenal suppression, bone density loss, cataract/glaucoma, growth velocity reduction in children.
• Use lowest effective dose; step down when controlled.
• Not for acute bronchospasm – use SABA (albuterol).

Pulmicort is a cornerstone controller medication. Regular review ensures optimal benefit-risk balance.