Common questions about budesonide inhalers - Brand names: Pulmicort, Budelin

Budesonide is a type of medicine known as a steroid or corticosteroid.

Steroids closely copy the effects of natural hormones produced in your adrenal glands. The adrenal glands are above your kidneys.

Budesonide inhalers are called preventers. They work by reducing the activity of your immune system. This reduces the swelling in your lungs that makes it difficult to breathe. It also helps prevent you getting symptoms such as wheezing and coughing.

Budesonide on its own does not work as a reliever to help treat an asthma attack when you suddenly get coughing, wheezing and breathlessness. You'll usually be given a separate reliever inhaler.

An inhaler containing budesonide and formoterol (brand names Symbicort Turbohaler, DuoResp Spiromax, Fobumix Easyhaler and WockAIR) may be used as both a preventer and a reliever (to relieve any symptoms when you get them).

A budesonide inhaler does not work straight away. You need to keep using it every day, as prescribed, so it can build up protection in your airways over time. It may take several weeks to see the full benefits.

You'll usually start to wheeze less or feel less breathless after using a budesonide inhaler for 3 to 7 days.

Once your symptoms have improved, you should find you need to use your reliever inhaler less often.

If your shortness of breath or wheezing does not get better after 7 days, or if it gets worse, let your doctor or nurse know as soon as possible.

It's important to keep using your budesonide inhaler every day even if you feel better.

If you use your inhaler as recommended by your doctor, nurse or pharmacist you're unlikely to get any lasting side effects.

Inhalers generally deliver a small amount of steroid medicine exactly where you need it. This limits the amount of steroid reaching the rest of your body. It also keeps the risk of side effects as low as possible.

However, for children and teenagers using high doses of a steroid inhaler, their height and weight needs to be monitored carefully. This is to make sure the steroid is not affecting their growth. Talk to their doctor if you're worried. They'll be able to explain the benefits and risks of giving your child budesonide.

Adults using high doses of a budesonide inhaler have an increased risk of getting adrenal insufficiency or weak bones (osteoporosis) over time. This is because more of the steroid gets into your body.

Your doctor or nurse will monitor you closely and may prescribe medicines to help strengthen your bones. Calcium-rich foods (such as milk and cheese, or non-dairy milk alternatives with added calcium) and regular exercise can also help keep bones healthy.

Do not stop using your budesonide inhaler without speaking to your doctor or nurse first.

If you have an inhaler to control your asthma or COPD, your breathing problems may return if you suddenly stop using it.

You might feel wheezy or short of breath. Your chest may feel tight and you could start to cough.

Suddenly stopping treatment can make you feel unwell. Symptoms can include feeling drowsy, sick or tired, headaches and loss of appetite.

You do not need to stop using your budesonide inhaler before surgery. Suddenly stopping treatment can make you feel unwell and may give you symptoms.

If you're having surgery or emergency treatment, for example after an accident, tell the person treating you that you're taking budesonide. Your doctor may decide you need extra steroids for a while.

If you've been given a blue steroid treatment card, or red steroid emergency card, show your card to anyone treating you so they can plan your treatment.

As well as budesonide inhalers, there are other preventers that contain steroids such as beclometasone, mometasone, fluticasone and ciclesonide.

They can look very different and some are for adults only.

These steroid inhalers all work in the same way, but there are differences between how potent (strong) they are and how likely they are to cause side effects.

Talk to your doctor or specialist nurse about which is the best choice of steroid inhaler for you or your child.

It's important to only ever use your own budesonide inhaler. Your inhaler may be different to a friend's or relative's. Their inhaler might contain a different dose of budesonide.

Preventer inhalers are different from the inhalers used during asthma attacks. These are called bronchodilators or reliever inhalers.

For asthma, you may be prescribed an inhaler that contains budesonide combined with formoterol for use as both a preventer and an emergency reliever (brand names: Symbicort Turbohaler, DuoResp Spiromax, Fobumix Easyhaler and WockAIR).

Another name for this type of asthma treatment plan is maintenance and reliever therapy (MART).

Formoterol is a type of medicine that opens the airways, called a bronchodilator. It's similar to other bronchodilators used as emergency relievers, such as  salbutamol or terbutaline. They work quickly to open the airways into the lungs, making it easier for you to breath. Formoterol, however, works for longer than other bronchodilators to keep the airways open.

If you're prescribed an inhaler containing budesonide and formoterol for asthma, your GP or asthma nurse may tell you to use it every day as a preventer (maintenance) and also during an asthma attack as a reliever. This means you may use it more often.

Not all inhalers containing formoterol can be used as both a preventer and a reliever. Inhalers containing budesonide and formoterol are not always used as MART. They may simply be used as a preventer with a separate reliever inhaler for when you have an asthma attack.

Always follow the instructions from your doctor or asthma nurse and read the leaflet that comes with the inhaler.

Speak to your doctor, nurse or pharmacist if you're not sure how to use your inhaler.

Steroid emergency card (red card)

If you're prescribed steroid medicines such as budesonide, your adrenal glands may not make enough of the hormones your body needs. For example, you may not have enough cortisol, known as the stress hormone. This is known as adrenal insufficiency.

It's more likely to happen if you take high doses for a long time (especially tablets and injections) or if you regularly use different kinds of steroids at the same time (such as a steroid nasal spray and a steroid inhaler).

Your doctor or pharmacist will assess your risk of adrenal insufficiency based on the type and dose of steroids you're taking, and may recommend that you carry a red steroid emergency card. This card is the size of a credit card and fits in your wallet or purse.

The Addison's Disease Self-Help Group (ADSHG) website has more information about the NHS steroid emergency card.

Blue steroid card

If you're on a high dose of budesonide, your doctor or pharmacist will also give you a blue steroid treatment card. It tells you how you can reduce the risks of side effects. It also gives details of your doctor, how much budesonide you take and how long the treatment will last for.

If you need any medical or dental treatment, show your blue steroid card to the doctor or dentist.

Try not to smoke. Smoking irritates the lungs and will make your breathing problem worse.

Budesonide will also work better if you do not smoke.

Speak to your doctor, nurse or pharmacist if you're finding it hard to stop smoking. Stop smoking treatments are available on the NHS.

Budesonide does not affect any type of contraception, including the combined pill and emergency contraception.

For most people, using a budesonide inhaler will not affect their ability to drive a car or cycle.

However, if your eyesight is affected in any way, do not drive or cycle.

It's an offence to drive a car if your ability to drive safely is affected. It's your responsibility to decide if it's safe to drive. If you're in any doubt, do not drive.

Yes, you can drink alcohol while using a budesonide inhaler.

There are several things you can do to help your condition when you're living with asthma or living with COPD. These include:

• quit smoking – not smoking can significantly reduce how severe and frequent your symptoms are
• exercising regularly – exercise is unlikely to trigger your symptoms once you're on appropriate treatment
• eating healthily – aim for a healthy, balanced diet and lose excess weight if you need to
• getting vaccinated – it's a good idea to have the annual flu vaccine and the pneumococcal vaccination when offered
• trying an air filter – they do not remove all the allergens but some people find they help their symptoms