What is the role of Budesonide (corticosteroid) in managing asthma exacerbation?

From the Guidelines

Budesonide is a recommended treatment for asthma exacerbations, and its use should be considered alongside other therapies such as bronchodilators and systemic corticosteroids. For acute exacerbations, nebulized budesonide can be administered at doses of 0.5-1 mg every 12 hours for adults and 0.25-0.5 mg every 12 hours for children, typically for 5-7 days alongside bronchodilators 1. The most recent and highest quality study, published in 2009, supports the use of budesonide in asthma exacerbations, highlighting the importance of reducing airway inflammation and preventing bronchoconstriction 1.

Key Considerations

• Budesonide works by reducing airway inflammation, decreasing mucus production, and preventing bronchoconstriction.
• It's essential to use a spacer device with metered-dose inhalers to improve medication delivery and rinse your mouth after use to prevent oral thrush.
• Patients should continue their prescribed controller medications even after symptoms improve and follow up with their healthcare provider to adjust treatment as needed.
• While budesonide has fewer systemic side effects than oral corticosteroids, it may take several hours to days to achieve full therapeutic effect.

Treatment Guidelines

• For maintenance therapy following an exacerbation, budesonide inhalers are recommended at 200-800 mcg twice daily for adults and 100-400 mcg twice daily for children, adjusted based on symptom control.
• The total course of systemic corticosteroids for an asthma exacerbation requiring an ED visit or hospitalization may last from 3 to 10 days, and there is no need to taper the dose for courses of less than 1 week 1.
• ICSs can be started at any point in the treatment of an asthma exacerbation, and there is no known advantage for higher doses of corticosteroids in severe asthma exacerbations 1.

From the FDA Drug Label

Budesonide inhalation suspension does not treat the sudden symptoms (wheezing, cough, shortness of breath, and chest pain or tightness) of an asthma attack Always have a short-acting beta2-agonist medicine (rescue inhaler) with you to treat sudden symptoms.

Budesonide is not indicated for the treatment of asthma exacerbations. Instead, it is a long-term maintenance medicine used to control and prevent asthma symptoms. For sudden symptoms of an asthma attack, a short-acting beta2-agonist medicine (rescue inhaler) should be used. 2

From the Research

Budesonide for Asthma Exacerbation

• Budesonide is an inhaled corticosteroid (ICS) used in the treatment of asthma, including for the management of exacerbations 3, 4, 5, 6.
• The use of budesonide in combination with formoterol (a long-acting beta-agonist) as both maintenance and reliever therapy has been shown to reduce the risk of severe asthma exacerbations compared to standard therapy with fixed-dose ICS/LABA plus a short-acting beta-agonist (SABA) 3, 6.
• Budesonide/formoterol maintenance and reliever therapy has been demonstrated to be effective in reducing exacerbations, hospital admissions, and exposure to systemic corticosteroids in adults and adolescents with mild asthma 5.
• The efficacy of budesonide in moderate to severe asthma has been established, with a dose-response effect observed in adults and children 4.
• Budesonide administered via a dry-powder inhaler (Turbuhaler) or a nebulized formulation (Pulmicort Respules) has been shown to be effective in the treatment of moderate to severe asthma 4.

Dosage and Administration

• The recommended dosage of budesonide/formoterol for asthma exacerbation is 1-2 additional inhalations of 160/4.5 μg strength, with a maximum daily dose of 8 inhalations 7.
• Budesonide/formoterol maintenance and reliever therapy can be used as needed, with a dose of 160/4.5 μg twice daily plus as needed 6.

Comparison to Other Therapies

• Budesonide/formoterol maintenance and reliever therapy has been compared to standard therapy with fixed-dose ICS/LABA plus SABA, with results showing a reduction in severe exacerbations and improvement in asthma control 3, 6.
• The use of budesonide/formoterol as reliever medication during periods of unstable asthma has been shown to reduce the risk of severe exacerbations 6.