What is the appropriate use of budesonide (Corticosteroid) in treating respiratory and gastrointestinal conditions, such as asthma (Chronic Obstructive Pulmonary Disease) or Crohn's disease?

From the Guidelines

Budesonide is a highly effective corticosteroid for treating mild-to-moderate Crohn's disease, particularly when limited to the ileum and/or ascending colon, with a recommended dose of 9 mg once daily for 8 weeks, as supported by the most recent and highest quality evidence 1.

Key Points for Budesonide Use

• For gastrointestinal conditions like Crohn's disease, oral budesonide is preferred due to its high local potency and limited systemic absorption, reducing side effects compared to other corticosteroids.
• The dosage of 9 mg once daily for 8 weeks is as effective as prednisolone in inducing remission in patients with mild-to-moderate ileocaecal Crohn's disease, with significantly fewer side effects, as demonstrated in a randomised double-blind trial 1.
• Budesonide's effectiveness in respiratory conditions such as asthma is well-established, with common dosages ranging from 180-720 mcg twice daily for adults, adjusted based on severity, and it should be maintained consistently for optimal control of airway inflammation.
• Patients should be monitored regularly, and the dosage should be tapered after remission is achieved to minimize side effects and maintain quality of life.

Administration and Monitoring

• For respiratory conditions, budesonide should be administered via inhalation using metered-dose inhalers or nebulizers.
• Patients should rinse their mouth after inhaled doses to prevent oral thrush.
• Oral formulations should be taken as directed with meals for gastrointestinal conditions.
• Regular follow-up with healthcare providers is essential to monitor response and adjust treatment as needed, ensuring the best possible outcomes in terms of morbidity, mortality, and quality of life 1.

From the FDA Drug Label

Budesonide inhalation suspension is an inhaled corticosteroid medicine Budesonide inhalation suspension is a long-term maintenance medicine used to control and prevent asthma symptoms in children ages 12 months to 8 years. Inhaled corticosteroids help to decrease inflammation in the lungs. Budesonide inhalation suspension helps reduce swelling and inflammation in the lungs, and helps keep the airways open to reduce asthma symptoms.

The appropriate use of budesonide in treating respiratory conditions, such as asthma, is as a long-term maintenance medicine to control and prevent asthma symptoms in children ages 12 months to 8 years.

• It is used to reduce swelling and inflammation in the lungs and keep the airways open.
• It is not used to treat sudden symptoms of asthma.
• The use of budesonide in treating gastrointestinal conditions, such as Crohn's disease, is not mentioned in the provided drug label 2.

From the Research

Budesonide in Respiratory Conditions

• Budesonide is a potent, non-halogenated inhaled corticosteroid (ICS) used extensively in the treatment of asthma and chronic obstructive pulmonary disease (COPD) 3.
• The combination of budesonide and formoterol can be used as maintenance therapy in patients with asthma and COPD, and also as an as-needed reliever with anti-inflammatory properties 3, 4.
• Budesonide/formoterol combination therapy has been shown to be more effective than either component alone in addressing many important aspects of COPD, such as pulmonary function, symptoms, and exacerbation 4.

Budesonide in Gastrointestinal Conditions

• Oral budesonide is a glucocorticoid of primarily local action, used mainly in inflammatory bowel disease, such as Crohn's disease 5.
• Budesonide has approved indications for use in Crohn's disease, and its pharmacology, pharmacodynamics, and therapeutic use have been reviewed to facilitate its use and improve the accuracy of its prescription 5.

Triple Therapy with Budesonide

• Triple therapy with budesonide/glycopyrronium/formoterol fumarate dihydrate (BGF) has been evaluated in patients with COPD and phenotypic features of asthma, and has been shown to improve lung function, exacerbations, and health-related quality of life compared to dual therapies 6.
• BGF has been found to have benefits on lung function, exacerbations, and health-related quality of life versus dual therapies in patients with COPD and phenotypic features of asthma 6.

Comparative Effectiveness of Budesonide/Formoterol Therapy

• Budesonide/formoterol combination therapy has been compared to other therapies, such as fluticasone/salmeterol combinations, and has been found to have differences in exacerbation rates and rescue inhaler use 7.
• Real-world comparative effectiveness studies of budesonide/formoterol therapy have found it to be effective and appropriate for use in asthma and COPD, with fewer total exacerbations and more likely to meet treatment escalation recommendations 7.