What is Pulmicort for inhalation
According to international standards, Pulmicort is referred to as budesonide. The basis of the drug is a steroid hormone, which is characterized by a wide range of effects on the body.
The substance is produced by the adrenal cortex. Due to its powerful immunoregulatory effect, the hormone is used in many areas of medicine, including to achieve an anti-inflammatory effect.
The release form of the drug Pulmicort is a suspension that is in polyethylene containers (250 and 500 mcg/ml). The substance is also sold in the form of dosed powder for inhalation (one dose contains 100 and 200 mcg of budesonide).
Use of suspensions
The active ingredient that is part of Pulmicort is, as noted earlier, budesonide. 2 milliliters of a suspension of this medication contains one dose of the active ingredient, which can be 250 or 500 micrograms of the hormonal agent. The activity of budesonide, which is contained in the nebulas of the drug, is fifteen times higher compared to Prednisolone.
The instructions for the nebulas indicate that to prepare suspensions for laryngotracheitis in children for inhalation, you will need ingredients in the form of Pulmicort nebulas along with terbutaline solution, saline, fenoterol, salbutamol and acetylcysteine. All ingredients are mixed, and an inhalation suspension for children based on the drug is obtained. It can be used no later than half an hour after preparation.
Composition of the drug
The active ingredient of the drug Pulmicort is the glucocorticosteroid budesonide. Add as auxiliary components:
- sodium salt;
- sodium citrate and chloride;
- citric acid;
- polysorbate 80;
- purified water.
Action and indications for use
The action of the active substance of the drug is aimed at relieving inflammation and allergic reactions. Under the influence of budesonide, the mechanism for the production of anti-inflammatory agents is activated, which helps neutralize the inflammatory process.
Inhalations with Pulmicort can reduce the production of mucus and facilitate its removal. The drug’s effect is also aimed at reducing the production of nitric oxide. This avoids bronchospasm, which often happens with allergic reactions. Inhalations with Pulmicort promote hyperreactivity of the respiratory tract and help relieve swelling.
Thus, inhalations with Pulmicort are indicated for the following diseases:
- chronic obstructive pulmonary disease;
- allergic rhinitis;
- bronchial asthma;
- bronchitis, laryngitis (only in case of emergency, to quickly improve the patient’s condition).
Inhalations with Pulmicort are used for bronchial asthma
Pharmacological properties
Pharmacodynamics
Budesonide, an inhaled glucocorticosteroid, in recommended doses has an anti-inflammatory effect in the bronchi, reducing the severity of symptoms and the frequency of exacerbations of bronchial asthma with a lower incidence of side effects than when using systemic glucocorticosteroids. Reduces the severity of edema of the bronchial mucosa, mucus production, sputum formation and airway hyperreactivity. It is well tolerated during long-term treatment and does not have mineralocorticosteroid activity. The time for the onset of the therapeutic effect after inhalation of one dose of the drug is several hours. The maximum therapeutic effect is achieved 1–2 weeks after treatment. Budesonide has a preventive effect on the course of bronchial asthma and does not affect the acute manifestations of the disease. A dose-dependent effect on the content of cortisol in plasma and urine while taking Pulmicort was shown. At recommended doses, the drug has significantly less effect on adrenal function than prednisone at a dose of 10 mg, as shown in ACTH tests.
Pharmacokinetics
Absorption Inhaled budesonide is rapidly absorbed. In adults, the systemic bioavailability of budesonide after inhalation of Pulmicort suspension via a nebulizer is approximately 15% of the total prescribed dose and about 40–70% of the delivered dose. The maximum concentration in blood plasma is reached 30 minutes after the start of inhalation. Metabolism and distribution Bonding with plasma proteins averages 90%. The volume of distribution of budesonide is approximately 3 l/kg. After absorption, budesonide undergoes intense biotransformation (more than 90%) in the liver with the formation of metabolites with low glucocorticosteroid activity. The glucocorticosteroid activity of the main metabolites bβ-hydroxy-budesonide and 16α-hydroxyprednisolone is less than 1% of the glucocorticosteroid activity of budesonide. Elimination Budesonide is metabolized mainly by the enzyme CYP3A4. Metabolites are excreted unchanged in the urine or in conjugated form. Budesonide has a high systemic clearance (about 1.2 l/min). The pharmacokinetics of budesonide is proportional to the administered dose of the drug. The pharmacokinetics of budesonide in children and patients with impaired renal function have not been studied. In patients with liver disease, the residence time of budesonide in the body may increase.
Dosage
In the case of maintenance therapy, the daily dose of the drug for adults should not exceed 4 mg. It is recommended to start treatment with small doses (no more than 2 mg per day), gradually increasing to 4 mg. In case of exacerbation, the total daily dose can be adjusted upward, but only with the permission of the doctor.
If the daily dose fluctuates within 1 mg, then one inhalation will be sufficient. Otherwise, two or more procedures will be required.
The daily amount of the drug for children at the beginning of treatment varies from 0.25 to 0.5 mg. If necessary, the dosage can be increased, but the total dose should not exceed 1 mg per day.
Selection of solution for inhalation depending on the diagnosis
Medicines are determined by a general practitioner, infectious disease specialist, pulmonologist and other specialists depending on the diagnosis. If you choose a solution yourself, there is a high risk of complications, since you need to know how to dilute the solution for inhalation correctly.
Many drugs are diluted with saline solution. Some patients do not know which saline solution to inhale. To do this, use a sterile liquid from a pharmacy, which is drawn up with a syringe and transferred to a nebulizer.
It is not recommended to make your own saline solution from table salt, as it must be sterile. Therefore, the patient does not need to know how to prepare the solution for inhalation; it is only purchased.
Bronchitis
Bronchitis is an inflammatory disease of the bronchial tree. It can cause a dry or wet cough.
- Pertussin
. Liquefies and removes mucus. The drug is suitable for wet and dry cough. Has a strong antitussive effect. Adults inhale 15 ml 3 times a day before meals. For children from 3 to 6 years old, use 5 ml 2 times a day. After 6 years, use 10 ml 3 times a day.
- Lazolvan, Ambrohexal
. A solution for inhalation that thins and removes mucus. The product is based on ambroxol hydrochloride. According to the instructions for use, the product is used from 2 years of age in a concentration of 2 ml up to 2 times a day. Children over 6 years old: 3 ml 2 times a day. Adults: 4 ml 3 times a day.
- Mineral water Borjomi
or Narzan
. They contain salt, which helps moisturize the mucous membrane. The solution can be used for any age. In childhood, use 3-4 ml 2-3 times a day. Adults: 5 ml 3-4 times a day. - Chlorophyllipt
. Has an antiseptic effect. Suitable for bronchitis with purulent sputum. Dilution is carried out at a concentration of 1 ml of the drug per 10 ml of saline solution. Children receive 2 inhalations a day, 3 ml of solution. Adults can take 4 inhalations per day with a concentration of 5 ml of solution.
- ACC, Fluimucil
. Strongly liquefies and removes phlegm. Children from 2 to 6 years old use 2 ml of the product up to 2 times a day. From 6 to 12 years, the dosage is increased to 2 ml 3 times a day. Adults can use 3 mm up to 4 times a day.
- Pulmicort
. Refers to hormonal substances based on budesonide. Indicated for inflammatory bronchitis. It is diluted in a ratio of 1 ml of the drug per 2 ml of saline solution. For children aged 6 months and older, a dosage of 0.25-0.5 mg per day is used. For adults, the dosage is increased to 2 mg per day.
In order not to liquefy the sputum, all dosages should be observed in full.
Bronchospasm
With bronchospasm, the lumen of the bronchi narrows, so phlegm cannot escape.
- Berodual
. Expands the lumen of the bronchi, the degree of action depends on the amount of the drug. For children under 6 years of age, the product should be used no more than 10 drops. For children over 6 years old, use up to 40 drops, depending on the severity of the disease. Adults can use 80 drops under the same criteria.
- Pulmovent
. The solution for inhalation, according to the instructions, eliminates bronchospasm. Children under 6 years of age are prescribed up to 12 drops. After 6 years, use up to 24 drops. Adults – up to 48 drops. Apply 3-4 times a day.
Bronchospasm is a dangerous condition that needs to be eliminated quickly.
Runny nose
Before inhalation, it is recommended to clear the nasal passages so that vapors pass unhindered.
- Sinupret
. A herbal remedy that relieves inflammation and swelling. Has a slight antibacterial effect. Eliminates inflammation in the sinuses. Use for children from 2 years old. It is diluted in a ratio of 1 ml of the drug to 2 ml of saline solution. Apply 2 times a day. For children over 6 years old, dilution is 1:2, used 2 times a day. For adults, dilution is 1:1, applied 3 times a day.
- Eucalyptus oil
. The drug is diluted in a ratio of 7 drops per 100 g. solution. Inhalation can only be done using steam devices, not nebulizers. Has a moisturizing and antibacterial effect. Relieves irritation and inflammation.
- Saline solution
. This is the most suitable remedy, has virtually no contraindications, and can be used at any age. Parents should know how to inhale saline solution for their child. Use a concentration of 2 ml for children, 4-5 ml for adults. Inhalations are done 2-3 times a day. How to fill an inhaler with saline solution: the liquid is placed in a container and the lid is screwed on tightly, the tubes and mask are connected.
You can also use inhalations with Narzan and Borjomi in the same concentration.
Sinusitis
Sinusitis is an inflammatory process in the nasal sinuses. The same medications are used as for a runny nose, but systemic antibacterial agents must be used.
Pharyngitis
Pharyngitis is an inflammation of the throat and surrounding lymphoid tissue.
- Tonsilgon N
. Herbal, antiseptic. Suitable for children from birth. For children from 1 year of age, use 1 ml of the drug per 2 ml of saline solution. For adults, use in a 1:1 ratio. Use 1-2 times a day.
- Rotokan
. This product is based on chamomile and calendula. Has an antiseptic, calming effect. To obtain the required liquid, 10 ml of the drug is diluted with 50 ml of saline solution. For children, use a concentration of 2 ml 2 times a day; adults can use 4 ml 4 times a day.
For pharyngitis, products are rarely used; they are mainly used for rinsing.
Laryngitis
Laryngitis is an inflammation of the larynx that accompanies a cold.
- Dexamethasone
. A hormonal agent indicated to relieve inflammation. How to make a solution for inhalation: 2 ml of the drug per 2 ml of saline solution. Indicated for use from the age of three. A one-time use is recommended to eliminate barking cough.
- The same drugs are used as for pharyngitis.
It is recommended to consult a physician before using a hormonal drug to reduce the risk of side effects.
Angina
Sore throat is a purulent inflammation of the tonsils.
- Chlorophyllipt
in the same dilution as for bronchitis.
- Miramistin
. Has an antiseptic, calming effect. How to prepare a solution for inhalation: 2 ml of product per 2 ml of saline solution. Inhalations 2 times a day.
- Furacilin
. Antibacterial agent. It is not bred, it has virtually no contraindications, and is applicable from childhood. Use 2 ml for children, 5 ml for adults. Can be used 2-3 times a day.
If a side effect occurs from the chosen drug, you should immediately stop using it. After completing treatment, it is recommended to be examined again by a doctor.
Inhalation of Pulmicort using a nebulizer
The drug is intended for inhalation using a special device - a nebulizer, which is equipped with a mouthpiece and a special mask. For adults, as a rule, a mouthpiece is used, since this category of patients is able to inhale the therapeutic aerosol evenly and calmly. The mask is intended mainly for children.
Carrying out inhalations using a nebulizer
How to dilute Pulmicort for inhalation
Pulmicort suspensions are not intended for ultrasonic nebulizers. In this case, any other type of device will do. Before use, the drug must be diluted with the amount of liquid indicated in the nebulizer instructions (usually 2–4 ml). For dilution, ipratropium bromide or 0.9% sodium chloride solution, etc. are usually used. There is no need to prepare a supply of the composition, as it must be used within half an hour. It is recommended to do this immediately before inhalation.
How to breathe correctly
Inhalation is allowed no earlier than 90 minutes after meals and heavy physical activity. The prepared solution is placed in a special nebulizer container and the procedure begins. Its duration depends on the amount of fluid administered. This usually lasts from 10 to 15 minutes. Before manipulation, it is important to wash your hands, this will prevent germs from entering parts of the device.
Carrying out inhalation with a nebulizer
Inhalation of Pulmicort for coughing should be treated with special care. Diseases of the larynx, lungs, trachea, and bronchi require calm inhalation of a therapeutic aerosol through the mouth. The inhalation should be deep, after which it is important to hold your breath for a few seconds and then calmly exhale through your nose.
At the end of the procedure, the nebulizer must be thoroughly cleaned (how to do this correctly is indicated in the device instructions).
When inhaling with a nebulizer, children use a special mask that covers the mouth and nose. Before the procedure, the child needs to wash his hands and treat his face with an antibacterial agent. After inhalation, wash your face and rinse your mouth with water. Taking into account the features of the drug, this will reduce the risk of developing mucosal candidiasis and skin irritation.
Inhalation of Pulmicort is recommended to be carried out at a temperature not exceeding 37.5 degrees. The restriction is caused by the possibility of worsening the condition due to bronchitis, pneumonia or infection. However, if attacks of suffocation or bronchospasm occur, you can breathe Pulmicort even at high temperatures.
special instructions
To minimize the risk of fungal infection of the oropharynx, the patient should be instructed to thoroughly rinse the mouth with water after each inhalation of the drug.
Co-administration of budesonide with ketoconazole, itraconazole or other potential CYP3A4 inhibitors should be avoided. If budesonide and ketoconazole or other potential CYP3A4 inhibitors have been prescribed, the time between doses should be increased to the maximum possible.
Use for children
Steam inhalations of Pulmicort should be carried out with caution in children
Steam inhalations of Pulmicort are prescribed to children with extreme caution. Depending on the condition and age of the child, the doctor develops a dosage regimen.
To eliminate acute laryngotracheitis, which often manifests itself as an intense cough and hoarseness, 2 procedures are prescribed over 2–3 days. If Pulmicort is used as the main therapy, more procedures will be required. As an emergency medical aid, the drug is prescribed for laryngitis and bronchitis. In this case, its use does not exceed 3 days. To improve sputum discharge and reduce its production, it is recommended to alternate Pulmicort inhalation with saline solution.
If a child has shortness of breath, emergency use of inhalations using two drugs is required: Pulmicort and Berodual. The intervals between procedures should be at least 20 minutes. First of all, inhalation with Berodual is used, this allows you to relieve spasm, and then the Pulmicort procedure is carried out.
Instructions
This medicine is available in the form of turbuhaler and suspensions - Pulmicort nebulas are actively used for laryngitis in children for inhalation in a nebulizer. A mask and mouthpiece are required. This is necessary for the child to take deep breaths, so that the medication can be evenly distributed in the respiratory system.
It is important to find out in advance how to dilute Pulmicort with saline for children.
According to experts, the medication is excellent for the treatment of chronic respiratory pathologies in children, while at the same time being a very effective prophylactic agent. Upon completion of inhalation of Pulmicort (any of its release formats), you should rinse your mouth as thoroughly as possible with boiled water in order to prevent the occurrence of oropharyngeal candidiasis.
Cleaning the nebulizer after inhalation should be done after every second use. Thus, the device needs to be thoroughly dried and washed, and the mask and mouthpiece need to be treated after each use.
What are the proportions of Pulmicort and saline solution for a child? First, let's find out the dosage of the drug.
Use during pregnancy
Inhalation of Pulmicort during pregnancy is not harmful
Many doctors claim that budesonide does not have a teratogenic effect, so inhalation of Pulmicort does not harm either children or expectant mothers. Despite such statements, clinical trials have not been conducted on this matter, so the use of the medication is advisable if the benefits of taking it outweigh the possible risk to the baby.
As for the lactation period, there is also no data on the negative effects of budesonide on a child during this period. Although the drug itself passes into mother's milk. When breastfeeding, doctors allow the use of Pulmicort inhalations. In any case, during pregnancy and lactation, the dosage of the drug should be minimal, and inhalations should be as infrequent as possible.
Interaction with other drugs
Systemic exposure to a is minimal, since its metabolites are practically undetectable in the blood. However, combined use with estrogens increases the systemic exposure of the drugs. To enhance the therapeutic effect of inhalations, drugs to dilate the bronchi may be prescribed. No other interactions of Pulmicort have been described.
Pulmicort is not contraindicated with other drugs
Harm and side effects
The drug may cause reversible growth retardation. In most cases, systemic complications are possible only with large dosages of the drug.
Uncontrolled use of Pulmicort for inhalation in rare cases provokes:
- dry throat;
- adrenal hypofunction;
- coughing attacks;
- irritation of the mucous membrane occurs;
- skin rash;
- fungal infection of the oral mucosa;
- bronchospasm;
- headache.
Sometimes patients' behavior changes, depression and increased excitability occur. Using a mask during inhalation may cause skin irritation and bruising on the face.
Side effect
The frequency of occurrence of undesirable effects is presented as follows: often (>1/100, <1/10); uncommon (>1/1000, <1/100); rare (>1/10000, <1/1000); very rare (<1/10000), including isolated reports.
Up to 10% of patients taking the drug may experience the following side effects.
From the respiratory system: often - oropharyngeal candidiasis, moderate irritation of the pharyngeal mucosa, cough, hoarseness, dry mouth, pneumonia (in patients with COPD); rarely - bronchospasm.
From the immune system: rarely - angioedema, immediate and delayed hypersensitivity reactions, including rash, contact dermatitis, urticaria, angioedema, bronchospasm and anaphylactic reaction.
From the nervous system: rarely - nervousness, excitability, depression, behavioral disorders.
On the part of the organ of vision: very rarely - cataracts, glaucoma (systemic effect).
From the digestive system: rarely - nausea.
From the skin and subcutaneous tissues: rarely - the appearance of bruises on the skin.
Laboratory indicators: very rarely - decrease in bone mineral density (systemic effect).
Taking into account the risk of developing oropharyngeal candidiasis, the patient should thoroughly rinse his mouth with water after each inhalation of the drug.
In rare cases, symptoms caused by the systemic effect of corticosteroids may occur, including adrenal hypofunction and growth retardation in children. The severity of these symptoms likely depends on the dose of the drug, duration of therapy, concomitant or previous GCS therapy, as well as individual sensitivity.
There have been cases of facial skin irritation when using a nebulizer with a mask. To prevent irritation, your face should be washed with water after using the mask.
Analogs
To relieve an attack of bronchial asthma and improve lung function, the use of medications similar to the action of Pulmicort is allowed.
Drugs that can replace Pulmicort must contain a similar active ingredient - budesonide. Today medicine can offer a number of analogues, including:
Budenit Steri-Neb is often prescribed as a replacement for Pulmicort for children. When choosing analogues of the drug, you need to look at the contraindications; many of them are not allowed for children.
