Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
DRUG CLASS AND MECHANISM: Budesonide is a man-made glucocorticoid steroid related to the naturally-occurring hormone, cortisol or
hydrocortisone which is produced in the adrenal glands. It is used for treating asthma by inhalation.
Glucocorticoid steroids such as cortisol or budesonide have potent anti-inflammatory actions that reduces inflammation and hyper-reactivity (spasm) of the airways caused by asthma. When used
as an inhaler, the budesonide goes directly to the inner lining of the inflamed airways to exert its effects. Only 39% of an inhaled dose of budesonide
is absorbed into the body, and the absorbed budesonide contributes little to the effects on the airways.
GENERIC AVAILABLE: No
PRESCRIPTION: Yes
PREPARATIONS:
Pulmicort Turbuhaler 200 mcg: each 200 mcg actuation delivers 160 mcg of budesonide.
Pulmicort Respules, 0.25 mg/2ml, 0.5 mg/2ml suspension, and 1 mg/2ml
STORAGE: Budesonide should be stored at room temperature, 20-25 C (68-77 F).
PRESCRIBED FOR: The budesonide inhaler is used for the control of
asthma in persons requiring continuous, prolonged treatment. Such patients may
include those with frequent asthmatic episodes requiring bronchodilators,
for example, albuterol (Ventolin) or those with asthmatic episodes at night.
DOSING: Budesonide is used to prevent asthmatic attacks and should
not be used to treat an acute attack of asthma. The Turbuhaler is used for
individuals six years of age or older. Effects can be seen within 24 hours, but
maximum effects may not be seen for 1-2 weeks or longer. Doses vary widely.
Adults usually receive 1 to 4 actuations (puffs) twice daily. Children usually receive 1
to 2 puffs twice daily. For those with mild asthma, treatment once daily may be sufficient.
Pulmicort Respules are used for individuals 12 months to eight years of age. Effects are seen in 2
to 8 days, but maximum effects may not be seen for up to 4 to 6 weeks. Pulmicort Respules are used with a jet nebulizer. They usually are taken as one or two doses for a total of 0.5-1 mg daily.
DRUG INTERACTIONS:Ketoconazole
(Nizoral, Extina, Xolegel, Kuric) increases the concentrations in blood of budesonide, and this may lead to an increase in the side effects of budesonide. No drug interactions have been described with
inhaled budesonide.
PREGNANCY: When given orally to animals, glucocorticoid steroids similar to budesonide
have been shown to cause fetal abnormalities. Studies of
pregnant women using inhaled budesonide during early pregnancy, however, do not show an increase in the rate of fetal abnormalities. Nevertheless, since these studies cannot exclude the possibility of rare effects on the fetus, inhaled budesonide should be used with caution during pregnancy.
NURSING MOTHERS: It is not known if budesonide is
secreted in breast milk. Other medications similar to budesonide are indeed secreted in
breast milk. It is not known whether the small amounts that may appear in
breast milk have effects on the infant.
SIDE EFFECTS: The most commonly noted side effects associated
with inhaled budesonide are mild cough or wheezing; these effects may be
minimized by using a bronchodilator inhaler, for example, albuterol (Ventolin),
prior to the budesonide. Oral candidiasis or thrush (a fungal infection of the throat) may occur in 1 in 25
persons who use budesonide without a spacer device on the inhaler. The risk is even higher
with large doses but is less in children than in adults. Hoarseness or sore throat also may occur in 1 in 10
persons. Using a spacer device on the inhaler and washing one's mouth out with water
following each use reduces the risk of both thrush and hoarseness. Less commonly, alterations in voice may occur.
COPD (chronic obstructive pulmonary disease) is a disorder that persistently obstructs bronchial airflow. COPD mainly involves three related conditions, chronic bronchitis, chronic asthma, and emphysema. Symptoms of COPD include chronic cough, shortness of breath, frequent respiratory infections, wheezing, morning headaches, and pulmonary hypertension. Treatment of COPD is focused on the related condition(s).
Asthma is a common disorder in which
chronic inflammation of the bronchial tubes (bronchi) makes them swell, narrowing the airways. Signs and symptoms include shortness of breath, chest tightness,
cough and wheezing.
Emphysema is a progressive disease of the lungs. The primary cause of emphysema is smoking. Alpha 1-antitrypsin deficiency is a rare disorder that has a genetic predisposition to emphysema. Aging, IV drug use, immune deficiencies, and connect tissue illnesses are also risk factors for emphysema. Emphysema is a subtype of COPD (chronic obstructive pulmonary disease, COLD). Symptoms include shortness of breath and wheezing. Management of symptoms may be achieved with medications, quitting smoking, pulmonary rehabilitation, or surgery.
Asthma, the main cause of chronic illness in children, has signs and symptoms in children that include frequent coughing spells, low energy while playing, complaints of chest "hurting," wheezing while breathing, shortness of breath, and feelings of tiredness. Treatment will involve a doctor creating an asthma action plan which will describe the use of asthma medications and when to seek emergency care for the child.
There are many unusual symptoms of asthma, including sighing, difficulty sleeping, anxiety, chronic cough, recurrent walking pneumonia, and rapid breathing. These symptoms may vary from individual to individual. These asthma complexities make it difficult to accurately diagnose and treat asthma.
There are two types of asthma medications: long-term control with anti-inflammatory drugs and quick relief from bronchodilators. Asthma medicines may be inhaled using a metered dose inhaler or nebulizer or they may be taken orally. People with high blood pressure, diabetes, thyroid disease, or heart disease shouldn't take OTC drugs like Primatene Mist and Bronkaid.
Patients suffering from episodes of asthma do not always have the
typical symptoms of asthma such as shortness of breath, chest tightness, and
wheezing (symptoms of airway narrowing). Instead, patients can have symptoms
that may not appear to be related to asthma. These "unusual" asthma symptoms
include
rapid breathing,
sighing,
fatigue and inability to
exercise properly,
difficulty sleeping,
anxiety and difficulty
concentrating,
chronic cough without wheezing,
protracted cough after an upper respiratory illness,
recurrent diagnosis of walking pneumonia, and
noises emanating from the chest usual during exhalation.
To complicate matters, symptoms of asthma are not consistent and often vary
from time to time in an individual. In some patients, symptoms are influenced by
diurnal factor...
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