Inhaler Budesonid Isihayler is not intended for the treatment of acute bronchospasm or asthmatic status. These conditions should be treated in accordance with current recommendations.
Patients should remember that budesonide Isihheler inhalation powder is a prophylactic drug, and therefore, to ensure optimal performance, it must be used regularly, even in the absence of symptoms of bronchial asthma, and do not stop taking it abruptly.
The transfer of patients receiving glucocorticosteroids by ingestion to inhaled glucocorticosteroids and their further treatment require additional therapeutic measures.
Before starting therapy with a high dose of inhaled glucocorticosteroids taken twice a day, the patient's asthma should be quite stable, and inhalations should be performed in addition to the usual maintenance dose of systemic glucocorticosteroids.
Approximately 10 days later start cancellation systemic glucocorticosteroids, gradually reducing their daily dose (e.g., monthly, reducing the dose to 2.5 mg of prednisolone or another drug - the equivalent value) to the minimum possible level. Sometimes it is possible to completely replace the intake of glucocorticosteroids by inhalation.
When transferring to inhaled glucocorticosteroids patients with impaired function of the adrenal cortex, in times of stress, such as during surgery, the development of infections weighting asthma attacks may require supplemental assignment systemic glucocorticosteroids. This also applies to patients receiving long-term therapy with high doses of inhaled glucocorticosteroids.
When translated from the receiving glucocorticosteroid budesonide inwards on inhalation may develop symptoms which previously suppressed systemic glucocorticoid therapy, e.g., the symptoms of allergic rhinitis, eczema, muscle and joint pains. To stop such symptoms, specific treatment methods should be added to the therapy.
In some patients, the development of a general malaise due to cancellation of the systemic intake of glucocorticosteroids is possible, despite the preservation or even improvement of the respiratory function. In such cases, patients should be instructed to continue treatment with budesonide inhalations and to stop taking glucocorticosteroids internally, despite the presence of clinical indications for cancellation of inhalations, for example, symptoms indicative of adrenal insufficiency.
As with other methods of inhalation therapy, paradoxical bronchospasm may develop, manifested by the immediate increase in wheezing and the feeling of lack of air after inhalation of the dose of the drug. Paradoxical bronchospasm is stopped with high-speed inhaled bronchodilators, and treatment should be carried out immediately. You must immediately cancel budesonide, conduct a patient examination and, if necessary, prescribe alternative methods of treatment.
If, despite proper control of the treatment, there was an episode of acute dyspnea, you need to apply a high-speed inhalation bronchodilator and revise the prescribed treatment.In cases where, despite the maximum dose of inhaled glucocorticosteroids, asthma symptoms can not be properly controlled, patients may need a short-term course of systemic glucocorticosteroids. In such situations, therapy with inhaled glucocorticosteroids should be supplemented with systemic drug preparations.
Systemic consequences of ingestion of inhaled glucocorticosteroids can be observed, in particular, when high doses are prescribed for a long period of time. These consequences are much less likely than the effects of taking oral glucocorticosteroids. Possible Cushing's effects include Cushing's syndrome, Cushingoid appearance, adrenal suppression, growth retardation in children and adolescents, a decrease in bone mineral density, cataracts, glaucoma and, much less often, various psychological and behavioral abnormalities, including psychomotor hyperactivity, sleep disorders, anxiety, depression or aggressiveness (especially in children).
Therefore, it is very important that the dose of an inhaled glucocorticosteroid is brought to a minimum level, at which the effectiveness of asthma control remains.
If, despite the use of maximum doses of inhaled glucocorticosteroids, asthma symptoms are not adequately controlled, patients may require a short course of treatment with systemic glucocorticosteroids. In such cases it is necessary to continue therapy with inhaled glucocorticosteroids in combination with treatment with systemic glucocorticosteroids.
There may be an increased risk of developing pneumonia in patients with newly diagnosed COPD who begin treatment with inhaled glucocorticosteroids.
In children receiving long-term therapy with inhaled glucocorticosteroids, it is recommended to regularly measure growth. If growth slows down, a treatment regimen should be revised to reduce the dose of an inhaled glucocorticosteroid, if possible, to a minimum, ensuring the maintenance of effective control of the course of bronchial asthma. In addition, it is necessary to send the patient to the pediatrician-pulmonologist.
In the period of therapy with inhaled glucocorticosteroids, oral candidiasis can be observed. In order to reduce the risk of oral candidiasis and hoarseness, patients should rinse the mouth well or brush their teeth after every intake of an inhaled glucocorticosteroid.Oral candidiasis may require treatment with appropriate antifungal drugs, and some patients may even need to interrupt treatment with inhaled glucocorticosteroids.
Patients who have a history of dependence on ingested glucocorticosteroids, caused by long-term systemic therapy of glucocorticosteroids, develop adrenocortical dysfunction. To restore it after therapy with glucocorticosteroids inside may take a long time, and therefore, when transferring patients with the dependence on orally taken glucocorticosteroids on budesonide the risk of dysfunction of the adrenal cortex may persist for a fairly long time. In such cases, the function "hypothalamus-hypophysis-adrenal cortex" should be regularly monitored.
Exacerbation of clinical manifestations of bronchial asthma may be due to acute bacterial infections of the respiratory tract, and this may require treatment with appropriate antibiotics. In such cases, patients sometimes have to increase the dose of inhaled budesonide and conduct a short course of glucocorticosteroid therapy inside.As a first-line therapy for relief of asthma attacks, high-speed inhaled bronchodilators should be used.
Before starting therapy with budesonide Ishihler inhaler, patients with active or inactive form of pulmonary tuberculosis should conduct specific diagnostic and adequate specific treatment measures to ensure control of this disease. Similarly, in patients with fungal, viral or other respiratory infections, careful observation and specific therapy should be provided and Budesonide Isihairer inhaler used only when adequate therapy for these infections is provided.
Patients with excessive mucus secretion in the respiratory tract may need a short course of glucocorticosteroid therapy inside.
In patients with severe impairment of liver function, treatment with inhaled budesonide can lead to a decrease in the rate of excretion of the drug, and, consequently, to an increase in its systemic bioavailability. In this case, the systemic effects of the drug may develop,so these patients should regularly monitor the function of the "hypothalamus - pituitary - adrenal cortex" system.
Simultaneous administration of ketoconazole and other potent inhibitors of the CYP3A4 isoenzyme should be avoided. If this is not possible, the time intervals between receptions of interacting drugs should be set as large as possible.
Patients with rare hereditary lactose intolerance syndromes, lactase deficiency (Lapp syndrome) or impaired absorption of glucose and galactose, this drug can not be taken.