What is the role of Budesonide (Corticosteroid) in Chronic Obstructive Pulmonary Disease (COPD)?

From the Guidelines

Budesonide is recommended for COPD patients with frequent exacerbations or those with significant symptoms despite bronchodilator therapy, as part of a combination therapy with a long-acting beta-agonist (LABA). The typical dosage is 320-400 mcg twice daily via inhaler. Budesonide works as an inhaled corticosteroid (ICS) to reduce airway inflammation, decrease mucus production, and improve lung function in COPD patients, as supported by the Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 report 1. It's particularly beneficial for those with eosinophilic inflammation or asthma-COPD overlap.

Key Considerations

• Patients should rinse their mouth after each use to prevent oral thrush, a common side effect.
• Other potential side effects include hoarseness, oral candidiasis, and increased risk of pneumonia, as noted in the prevention of acute exacerbations of COPD guideline 1.
• Budesonide should be used as maintenance therapy, not for rescue during acute exacerbations.
• Regular follow-up is important to assess effectiveness and adjust treatment as needed, with consideration of the patient's health-related quality of life, dyspnea, and rescue medication use 1.
• For optimal benefit, patients should use proper inhaler technique and adhere to the prescribed regimen consistently.

Treatment Approach

• The combination of ICS and LABA is more effective than individual components in improving lung function and health status and reducing exacerbations in patients with exacerbations and moderate to very severe COPD, as stated in the Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 report 1.
• Triple inhaled therapy of ICS/LAMA/LABA may improve lung function, symptoms, and health status and reduce exacerbations compared with ICS/LABA or LAMA monotherapy, although more evidence is needed to compare the benefits of triple therapy to LABA/LAMA 1.

From the Research

Budesonide in COPD

• Budesonide is an inhaled corticosteroid (ICS) used in the treatment of chronic obstructive pulmonary disease (COPD) 2.
• The efficacy and safety of budesonide/glycopyrronium/formoterol fumarate (BUD/GLY/FOR) have been compared to other triple combination therapies in COPD, showing comparable results in reducing exacerbation rates and improving lung function, symptoms, and health-related quality of life 2.
• BUD/GLY/FOR has been found to have a comparable safety and tolerability profile to other triple combination therapies 2.

Management of COPD Exacerbations

• The management of COPD exacerbations is crucial to prevent complications and improve patient outcomes [(3,4,5)].
• Treatment strategies for COPD exacerbations include pharmacologic and non-pharmacologic interventions, such as inhaled bronchodilators, systemic steroids, antibiotics, and pulmonary rehabilitation [(3,4,5)].
• The use of long-acting muscarinic agents (LAMA) and long-acting beta2-agonists (LABA) as initial bronchodilator treatment in COPD has been compared, with LAMA found to be more effective in patients with prior exacerbations 6.

Role of Budesonide in COPD Treatment

• Budesonide is used as part of a triple combination therapy (BUD/GLY/FOR) in the treatment of COPD, particularly in patients with moderate-to-very severe COPD 2.
• The use of inhaled corticosteroids, such as budesonide, in COPD treatment has been found to have benefits and risks, and future research is needed to tailor treatment strategies for specific COPD phenotypes 4.