Asthma and COPD Treatment Guidelines

Introduction to Budesonide Treatment

For patients with asthma, the European Respiratory Society recommends administering Pulmicort (budesonide) at 0.5 mg twice daily via nebulizer for most patients, with dosing adjusted based on disease severity; while for COPD patients, budesonide is not a first-line treatment but may be considered at similar doses in specific cases showing steroid responsiveness 1
Standard bronchodilator treatment should be first-line therapy for COPD patients, according to the European Respiratory Society 1, 2
Budesonide is not routinely recommended for all COPD patients, as stated by the European Respiratory Society 2

Consider a trial of budesonide in COPD patients with a fast rate of FEV₁ decline (>50 mL/year), as suggested by the European Respiratory Society 2
Consider a trial of budesonide in COPD patients with frequent exacerbations despite optimal bronchodilator therapy, according to the European Respiratory Society 1
Patients with features of both asthma and COPD may require different treatment approaches, as noted by the European Respiratory Society 1, 2

For acute exacerbations, use an oxygen-driven nebulizer for asthma and an air-driven nebulizer for COPD (to avoid CO₂ retention), as recommended by the European Respiratory Society 1
Face mask or mouthpiece are equally effective for nebulizer use, though breathless patients may prefer face masks, according to the European Respiratory Society 1
For high doses (≥1,000 μg/day), use a large-volume spacer or dry-powder system, as suggested by the European Respiratory Society 2

Evaluate response to budesonide treatment after 6 weeks, and continue only if objective improvement is documented (FEV₁ improvement ≥10% predicted and/or >200 mL), as recommended by the European Respiratory Society 2, 3
Once control is achieved, consider reducing to the lowest effective dose to minimize side effects, as noted by the European Respiratory Society 1, 2