Pulmicort Turbohaler

Pulmicort Turbuhaler contains budesonide, an inhaled corticosteroid (ICS) used as a preventer in the long-term management of persistent asthma and as maintenance therapy in COPD when frequent exacerbations warrant it.

Budesonide reduces airway inflammation by suppressing multiple inflammatory pathways.

It inhibits the release of cytokines, leukotrienes, and prostaglandins, decreases oedema of the airway mucosa, and reduces mucus hypersecretion.

These effects take days to weeks to develop fully, which is why Pulmicort must be used regularly — not as a reliever during acute attacks.

The Turbuhaler Device

The Turbuhaler is a breath-actuated dry-powder inhaler. It does not contain propellants and requires no hand-breath coordination.

The patient loads a dose by twisting the base and inhales forcefully to draw the powder into the lungs. This makes it well suited for patients who struggle with pressurised metered-dose inhalers.

Step-Down Approach

Once asthma is well controlled for at least three months, the ICS dose can often be stepped down to the lowest dose that maintains control. Never stop Pulmicort abruptly without medical advice.

Preparing and Using the Turbuhaler

Unscrew and remove the cap. Hold the inhaler upright. Twist the grip at the base fully in one direction, then back until you hear a click — this loads the dose.

Breathe out gently, away from the device. Place your lips firmly around the mouthpiece and inhale deeply and forcefully.

Hold your breath for up to ten seconds, then breathe out through your nose. If a second inhalation is needed, repeat the loading step.

Mouth Rinsing

Rinse your mouth with water and spit out after every use. This reduces the risk of oral thrush and hoarseness.

Cleaning

Wipe the outside of the mouthpiece weekly with a dry cloth. Do not wash the Turbuhaler with water.

Adults — Asthma

• Mild: 200-400 micrograms daily, in 1-2 divided doses
• Moderate: 400-800 micrograms daily
• Severe: up to 1,600 micrograms daily (specialist supervision)

Children (6 years and over)

• 100-400 micrograms daily, in 1-2 divided doses

COPD

• 400 micrograms twice daily (usually combined with a LABA)

Dose Adjustment

Titrate to the lowest effective dose once control is achieved. Higher starting doses may be needed during exacerbations, with step-down over weeks.

Common (up to 1 in 10 patients)

• Oral thrush (oropharyngeal candidiasis) — preventable by mouth rinsing
• Hoarseness (dysphonia)
• Cough after inhalation
• Throat irritation

Uncommon (up to 1 in 100 patients)

• Bruising of the skin
• Nervousness or restlessness
• Muscle cramps

Rare (up to 1 in 1,000 patients)

• Adrenal suppression, particularly at high doses over prolonged periods
• Growth retardation in children (usually small and manageable at recommended doses)
• Osteoporosis with long-term high-dose use
• Paradoxical bronchospasm (stop and treat with a reliever)

Very Rare (fewer than 1 in 10,000 patients)

• Cataracts or glaucoma
• Psychiatric effects (anxiety, depression, behavioural changes)

At standard doses, systemic side effects are uncommon because budesonide has high first-pass hepatic metabolism.

Not a Reliever

Pulmicort does not provide rapid relief during an acute asthma attack. Always have a short-acting bronchodilator (e.g., salbutamol or terbutaline) available for breakthrough symptoms.

Transferring from Oral Steroids

If switching from prednisolone tablets to inhaled budesonide, your doctor will taper the oral steroid gradually. Abrupt withdrawal of oral steroids can cause adrenal crisis.

Growth in Children

Monitor height regularly. Inhaled corticosteroids may slow growth slightly in the first year of treatment, but this effect is generally small and not progressive.

High-Dose Precautions

Patients on high-dose ICS should carry a steroid emergency card. In situations of severe physiological stress (surgery, trauma, severe infection), supplemental systemic steroids may be needed.

Do not use Pulmicort if you have:

• A known hypersensitivity to budesonide or lactose (the Turbuhaler contains lactose monohydrate)
• Active pulmonary tuberculosis
• Untreated fungal, bacterial, or viral respiratory infections

Pulmicort is not suitable for the relief of acute bronchospasm. It should always be used alongside a reliever inhaler.