You can set an example too ? how to effectively and safely use budesonide in nebulization? Review article
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Published:
Jun 15, 2025
Keywords:
budesonide, nebulization, nebulizers, asthma, acute laryngitis, COPD, children, adults
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Abstract
The basic pharmacokinetic and pharmacodynamic properties of budesonide in the form of a nebulization suspension are discussed. This drug is used in inhalation therapy of numerous inflammatory and obstructive respiratory diseases in newborns, infants, older children and adults. It is most often used in acute laryngitis (various forms) and asthma (exacerbations, chronic therapy). The most important principles of correct nebulization of budesonide using different nebulizers are given. Attention was drawn to possible errors during nebulization.
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How to Cite
Emeryk, A. (2025). You can set an example too ? how to effectively and safely use budesonide in nebulization?. Alergoprofil, 21(2), 3-9. https://doi.org/10.24292/01.AP.212010625
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THERAPY
Copyright: ? Medical Education sp. z o.o. This is an Open Access article distributed under the terms of the Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). License (https://creativecommons.org/licenses/by-nc/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.
Address reprint requests to: Medical Education, Marcin Kuźma (marcin.kuzma@mededu.pl)
References
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4. Husby S, Agertoft L, Mortensen S et al. Treatment of croup with nebulised steroid (budesonide): a double blind, placebo controlled study. Arch Dis Child. 1993; 68: 352-5.
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7. Murphy VE, Jensen ME, Gibson PG. Asthma during pregnancy: exacerbations, management, and health outcomes for mother and infant. Semin Respir Crit Care Med. 2017; 38: 160-73.
8. Global Strategy for Asthma Management and Prevention. 2025.
9. Lee S, Hetherington E, Leigh R et al. Impact of asthma medications during pregnancy on asthma exacerbation, maternal, and neonatal outcomes. J Allergy Clin Immunol Pract. 2024; 12: 1549-57.
10. Hvizdos KM, Jarvis B. Budesonide inhalation suspension: a review of its use in infants, children and adults with inflammatory respiratory disorders. Drugs. 2000; 60: 1141-78.
11. Berger WE. Budesonide inhalation suspension for the treatment of asthma in infants and children. Drugs. 2005; 65: 1973-89.
12. Shapiro G, Mendelson L, Kraemer MJ et al. Efficacy and safety of budesonide inhalation suspension (Pulmicort Respules) in young children with inhaled steroid-dependent, persistent astma. J Allergy Clin Immunol. 1998; 102: 789-96.
13. Drugs.com. Budesonide Inhalation Suspension: Package Insert/ Prescribing Info.
14. Emeryk A, Pirożyński M, Mazurek H et al. Polski Przewodnik Inhalacyjny. Wydanie III. Via Medica, Gdańsk 2024: 1-32.
15. Hatley RHM, Byrne SM. Variability in delivered dose and respirable delivered dose from nebulizers: are current regulatory testing guidelines sufficient to produce meaningful information? Med Devices (Auckl). 2017; 10: 17-28.
16. Amirav I, Newhouse MT. Deposition of small particles in the developing lung. Paediatr Respir Rev. 2012; 13: 73-8.
17. Werżanowski P, Pirożyński M. Zestawienie inhalatorów dostępnych w Polsce. In: ABC nebulizacji ze szczególnym uwzględnieniem dawkowania. Pirożyński M (ed.). Via Medica, Gdańsk 2015: 43-72.
18. Ari A, Hoops JA, Williams Z et al. Impact of normal, obstructive, and restrictive breathing patterns on aerosol drug delivery with jet and mesh nebulizers in simulated spontaneously breathing adults. Can J Respir Ther. 2025; 61: 71-6.
19. Tseng HY, Lin HL, Chiang HS et al. In vitro evaluation of aerosol delivery by hand-held mesh nebulizers in an adult spontaneous breathing lung model. J Aerosol Med Pulm Drug Deliv. 2022; 35: 83-90.
20. Pritchard JN, Hatley RH, Denyer J et al. Mesh nebulizers have become the first choice for new nebulized pharmaceutical drug developments. Ther Deliv. 2018; 9: 121-36.
21. Dobrowolska K, Emeryk A, Janeczek K et al. Influence of physicochemical properties of budesonide micro-suspensions on their expected lung delivery using a vibrating mesh nebulizer. Pharmaceutics. 2023; 15: 752.
22. Sosnowski TR, Kazimierczak I, Sawczuk A et al. Improving pulmonary delivery of budesonide suspensions nebulized with constant-output vibrating mesh nebulizers by using a valved holding chamber. Pharmaceutics. 2025; 17: 696.
23. Ari A. Jet, ultrasonic, and mesh nebulizers: an evaluation of nebulizers for better clinical outcomes. Eurasian J Pulm. 2014; 16: 1-7.
24. Knoch M. New generation nebulizers. J Aerosol Med Pulm Drug Deliv. 2024; 37: 157-65.
25. Emeryk A, Emeryk-Maksymiuk J. Glikokortykosteroidy w nebulizacji ? między lekiem, inhalatorem i pacjentem. Terapia. 2019; 27: 89-94.
26. Zhao Z, Xiong R, Cui Y et al. Efficacy of Nebulized Budesonide and Systemic Corticosteroids During Hospitalization on All-Cause Mortality in AECOPD Patients: A Real-World Study. Lung. 2025; 203: 30.
27. Pleasants RA, Wang T, Xu X et al. Nebulized corticosteroids in the treatment of copd exacerbations: systematic review, meta-analysis, and clinical perspective. Respir Care. 2018; 63(10): 1302-10.
28. Zhang Y, Lou H, Wang Y et al. Comparison of corticosteroids by 3 approaches to the treatment of chronic rhinosinusitis with nasal polyps. Allergy Asthma Immunol Res. 2019; 11: 482-97.
29. Samoliński B, Furmańczyk K, Emeryk A et al. Enhanced therapeutic options for budesonide nebulisation via pulsating nebuliser in upper respiratory tract diseases. Otolaryngol Pol. 2025; 79: 29-38.
30. Wongsurakiat P, Rattanawongpaibul A, Limsukon A et al. A Delphi consensus on nebulized budesonide for adults with asthma and COPD. Asian Pac J Allergy Immunol. 2025 Jun 3. doi: 10.12932/AP-190824-1910.
31. Doniec Z, Mastalerz-Migas A, Bręborowicz A et al. ReKOMendacje Postępowania w AStmie wczesnodziecięcej dla lekarzy Podstawowej Opieki Zdrowotnej ? KOMPAS POZ. Fam Med Prim Care Rev. 2016; 18(2): 181-92.
32. Skarżyńska MB, Gos E, Sanfins MD et al. The AMSA? manosonic nebulizer for ENT disease among children in Poland. Int J Pediatr Otorhinolaryngol. 2024; 186: 112113.
33. Zhou JF, Zhang YB, Zhang ZW. Comparison of clinical outcomes following delivery of budesonide by both vibrating mesh nebulizer and jet nebulizer in premature infants with bronchopulmonary dysplasia. Front Pediatr. 2024; 11: 1258846.
34. Flisiak R, Horban A, Jaroszewicz J et al. Zalecenia postępowania w zakażeniach SARS-CoV-2 Polskiego Towarzystwa Epidemiologów i Lekarzy Chorób Zakaźnych (26.04.2021). Wytyczne COVID-19. Medycyna Praktyczna dla Lekarzy 2021 r.
35. Bodasiński J, Emeryk A, Florkiewicz E et al. Nebulizacja: czym, jak, dla kogo, kiedy? Polski Konsensus Nebulizacyjny. Aktualizacja. Terapia. 2013; numer specjalny: 3-9.
36. Smith DK, McDermott AJ, Sullivan JF. Croup: diagnosis and management. Am Fam Physician. 2018; 97: 575-80.
37. Gates A, Gates M, Vandermeer B et al. Glucocorticoids for croup in children. Cochrane Database Syst Rev 2018; 8: CD001955.
38. Emeryk A, Piela A, Janeczek K et al. Kształtowanie właściwości chmury aerozolowej leków nebulizacyjnych. Część I. Podstawy teoretyczne. Lek Wojsk. 2024; 102: 259-63.
39. van den Bosch WB, Kloosterman SF, Andrinopoulou ER et al. Small airways targeted treatment with smart nebulizer technology could improve severe asthma in children: a retrospective analysis. J Asthma. 2022; 59: 2223-33.
40. Rayner DG, Ferri DM, Guyatt GH et al. Inhaled reliever therapies for asthma: a systematic review and meta-analysis. JAMA. 2025; 333: 143-52.
41. Global strategy for perevention, Diagnosis and Management of COPD: 2025 Report. goldcopd.org/2025-gold-report/.
42. Feng Z, Han Z, Wang Y et al. Comparison of the application of vibrating mesh nebulizer and jet nebulizer in chronic obstructive pulmonary disease: a systematic review and meta-analysis. Int J Chron Obstruct Pulmon Dis. 2024; 19: 829-39.
43. Nickerson C, Hollen DV, Garbin S et al. Pilot study to investigate the benefits of the InnoSpire Go Mesh Nebulizer compared to jet nebulizers in the treatment of stable COPD. J Aerosol Med Pulm Drug Deliv. 2022; 35: 186-95.
44. Fernandes RM, Bialy LM, Vandermeer B et al. Glucocorticoids for acute viral bronchioli tis in infants and young children. Cochrane Database Syst Rev 2013; 2013: CD004878.
45. Orzołek I, Ambrożej D, Makrinioti H et al. Severe bronchiolitis profiling as the first step towards prevention of asthma. Allergol Immunopathol (Madr). 2023; 51: 99-107.
46. Fernandes RM, Wingert A, Vandermeer B. Safety of corticosteroids in young children with acute respiratory conditions: a systematic review and meta-analysis. BMJ Open. 2019; 9: e028511.
47. Silverman M, Sheffer A, Diaz PV et al. Outcome of pregnancy in a randomized controlled study of patients with asthma exposed to budesonide. Ann Allergy Asthma Immunol. 2005; 95: 566-70.
48. Liu X, Agerbo E, Schlünssen V et al. Maternal asthma severity and control during pregnancy and risk of offspring asthma. J Allergy Clin Immunol. 2018; 141: 886-92.
49. Galván CA, Guarderas JC. Practical considerations for dysphonia caused by inhaled corticosteroids. Mayo Clin Proc. 2012; 87: 901-4.
50. Pirożyński M, Florkiewicz E, Radzikowski K et al. Praktyczne aspekty nebulizacji u dorosłych z podstawami zasad dawkowania aerozoli leczniczych. In: ABC nebulizacji ze szczególnym uwzględnieniem dawkowania. Pirożyński M (ed.). Via Medica, Gdańsk 2015: 144-86.
51. Krenke K, Jackowska T, Mazurek H et al. Terapia nebulizacyjna budezonidem ? czynniki decydujące o efekcie terapeutycznym. Stanowisko ekspertów. Przegl Pediatr. 2024; 53: 29-39.
52. Fink JB, Stapleton KW. Nebulizers. J Aerosol Med Pulm Drug Deliv. 2024; 37: 140-56.
53. Sosnowski TR, Janeczek K, Emeryk A et al. Nebulizator siateczkowy z komorą inhalacyjną ? nowinka techniczna czy istotny postęp w nebulizacji? Terapia. 2022; 2: 64-8.
54. Alcoforado L Paiva DN, Ari A et al. Does valved holding chamber improve aerosol lung deposition with a jet nebulizer? A randomized crossover study. Pharmaceutics. 2022; 14: 566.
2. Hamley P. Small molecule medicinal chemistry: strategies and technologies. John Wiley & Sons, 2015; 390.
3. Baker JW, Mellon M, Wald J et al. Multiple-dosing, placebo- controlled study of budesonide inhalation suspension given once or twice daily for treatment of persistent asthma in young children and infants. Pediatrics. 1999; 103: 414-21.
4. Husby S, Agertoft L, Mortensen S et al. Treatment of croup with nebulised steroid (budesonide): a double blind, placebo controlled study. Arch Dis Child. 1993; 68: 352-5.
5. Medycyna Praktyczna. Budezonid.
6. Derendorf H. Pharmacokinetic and pharmacodynamic properties of inhaled corticosteroids in relation to efficacy and safety. Respir Med. 1997; 91(suppl. A): 22-8.
7. Murphy VE, Jensen ME, Gibson PG. Asthma during pregnancy: exacerbations, management, and health outcomes for mother and infant. Semin Respir Crit Care Med. 2017; 38: 160-73.
8. Global Strategy for Asthma Management and Prevention. 2025.
9. Lee S, Hetherington E, Leigh R et al. Impact of asthma medications during pregnancy on asthma exacerbation, maternal, and neonatal outcomes. J Allergy Clin Immunol Pract. 2024; 12: 1549-57.
10. Hvizdos KM, Jarvis B. Budesonide inhalation suspension: a review of its use in infants, children and adults with inflammatory respiratory disorders. Drugs. 2000; 60: 1141-78.
11. Berger WE. Budesonide inhalation suspension for the treatment of asthma in infants and children. Drugs. 2005; 65: 1973-89.
12. Shapiro G, Mendelson L, Kraemer MJ et al. Efficacy and safety of budesonide inhalation suspension (Pulmicort Respules) in young children with inhaled steroid-dependent, persistent astma. J Allergy Clin Immunol. 1998; 102: 789-96.
13. Drugs.com. Budesonide Inhalation Suspension: Package Insert/ Prescribing Info.
14. Emeryk A, Pirożyński M, Mazurek H et al. Polski Przewodnik Inhalacyjny. Wydanie III. Via Medica, Gdańsk 2024: 1-32.
15. Hatley RHM, Byrne SM. Variability in delivered dose and respirable delivered dose from nebulizers: are current regulatory testing guidelines sufficient to produce meaningful information? Med Devices (Auckl). 2017; 10: 17-28.
16. Amirav I, Newhouse MT. Deposition of small particles in the developing lung. Paediatr Respir Rev. 2012; 13: 73-8.
17. Werżanowski P, Pirożyński M. Zestawienie inhalatorów dostępnych w Polsce. In: ABC nebulizacji ze szczególnym uwzględnieniem dawkowania. Pirożyński M (ed.). Via Medica, Gdańsk 2015: 43-72.
18. Ari A, Hoops JA, Williams Z et al. Impact of normal, obstructive, and restrictive breathing patterns on aerosol drug delivery with jet and mesh nebulizers in simulated spontaneously breathing adults. Can J Respir Ther. 2025; 61: 71-6.
19. Tseng HY, Lin HL, Chiang HS et al. In vitro evaluation of aerosol delivery by hand-held mesh nebulizers in an adult spontaneous breathing lung model. J Aerosol Med Pulm Drug Deliv. 2022; 35: 83-90.
20. Pritchard JN, Hatley RH, Denyer J et al. Mesh nebulizers have become the first choice for new nebulized pharmaceutical drug developments. Ther Deliv. 2018; 9: 121-36.
21. Dobrowolska K, Emeryk A, Janeczek K et al. Influence of physicochemical properties of budesonide micro-suspensions on their expected lung delivery using a vibrating mesh nebulizer. Pharmaceutics. 2023; 15: 752.
22. Sosnowski TR, Kazimierczak I, Sawczuk A et al. Improving pulmonary delivery of budesonide suspensions nebulized with constant-output vibrating mesh nebulizers by using a valved holding chamber. Pharmaceutics. 2025; 17: 696.
23. Ari A. Jet, ultrasonic, and mesh nebulizers: an evaluation of nebulizers for better clinical outcomes. Eurasian J Pulm. 2014; 16: 1-7.
24. Knoch M. New generation nebulizers. J Aerosol Med Pulm Drug Deliv. 2024; 37: 157-65.
25. Emeryk A, Emeryk-Maksymiuk J. Glikokortykosteroidy w nebulizacji ? między lekiem, inhalatorem i pacjentem. Terapia. 2019; 27: 89-94.
26. Zhao Z, Xiong R, Cui Y et al. Efficacy of Nebulized Budesonide and Systemic Corticosteroids During Hospitalization on All-Cause Mortality in AECOPD Patients: A Real-World Study. Lung. 2025; 203: 30.
27. Pleasants RA, Wang T, Xu X et al. Nebulized corticosteroids in the treatment of copd exacerbations: systematic review, meta-analysis, and clinical perspective. Respir Care. 2018; 63(10): 1302-10.
28. Zhang Y, Lou H, Wang Y et al. Comparison of corticosteroids by 3 approaches to the treatment of chronic rhinosinusitis with nasal polyps. Allergy Asthma Immunol Res. 2019; 11: 482-97.
29. Samoliński B, Furmańczyk K, Emeryk A et al. Enhanced therapeutic options for budesonide nebulisation via pulsating nebuliser in upper respiratory tract diseases. Otolaryngol Pol. 2025; 79: 29-38.
30. Wongsurakiat P, Rattanawongpaibul A, Limsukon A et al. A Delphi consensus on nebulized budesonide for adults with asthma and COPD. Asian Pac J Allergy Immunol. 2025 Jun 3. doi: 10.12932/AP-190824-1910.
31. Doniec Z, Mastalerz-Migas A, Bręborowicz A et al. ReKOMendacje Postępowania w AStmie wczesnodziecięcej dla lekarzy Podstawowej Opieki Zdrowotnej ? KOMPAS POZ. Fam Med Prim Care Rev. 2016; 18(2): 181-92.
32. Skarżyńska MB, Gos E, Sanfins MD et al. The AMSA? manosonic nebulizer for ENT disease among children in Poland. Int J Pediatr Otorhinolaryngol. 2024; 186: 112113.
33. Zhou JF, Zhang YB, Zhang ZW. Comparison of clinical outcomes following delivery of budesonide by both vibrating mesh nebulizer and jet nebulizer in premature infants with bronchopulmonary dysplasia. Front Pediatr. 2024; 11: 1258846.
34. Flisiak R, Horban A, Jaroszewicz J et al. Zalecenia postępowania w zakażeniach SARS-CoV-2 Polskiego Towarzystwa Epidemiologów i Lekarzy Chorób Zakaźnych (26.04.2021). Wytyczne COVID-19. Medycyna Praktyczna dla Lekarzy 2021 r.
35. Bodasiński J, Emeryk A, Florkiewicz E et al. Nebulizacja: czym, jak, dla kogo, kiedy? Polski Konsensus Nebulizacyjny. Aktualizacja. Terapia. 2013; numer specjalny: 3-9.
36. Smith DK, McDermott AJ, Sullivan JF. Croup: diagnosis and management. Am Fam Physician. 2018; 97: 575-80.
37. Gates A, Gates M, Vandermeer B et al. Glucocorticoids for croup in children. Cochrane Database Syst Rev 2018; 8: CD001955.
38. Emeryk A, Piela A, Janeczek K et al. Kształtowanie właściwości chmury aerozolowej leków nebulizacyjnych. Część I. Podstawy teoretyczne. Lek Wojsk. 2024; 102: 259-63.
39. van den Bosch WB, Kloosterman SF, Andrinopoulou ER et al. Small airways targeted treatment with smart nebulizer technology could improve severe asthma in children: a retrospective analysis. J Asthma. 2022; 59: 2223-33.
40. Rayner DG, Ferri DM, Guyatt GH et al. Inhaled reliever therapies for asthma: a systematic review and meta-analysis. JAMA. 2025; 333: 143-52.
41. Global strategy for perevention, Diagnosis and Management of COPD: 2025 Report. goldcopd.org/2025-gold-report/.
42. Feng Z, Han Z, Wang Y et al. Comparison of the application of vibrating mesh nebulizer and jet nebulizer in chronic obstructive pulmonary disease: a systematic review and meta-analysis. Int J Chron Obstruct Pulmon Dis. 2024; 19: 829-39.
43. Nickerson C, Hollen DV, Garbin S et al. Pilot study to investigate the benefits of the InnoSpire Go Mesh Nebulizer compared to jet nebulizers in the treatment of stable COPD. J Aerosol Med Pulm Drug Deliv. 2022; 35: 186-95.
44. Fernandes RM, Bialy LM, Vandermeer B et al. Glucocorticoids for acute viral bronchioli tis in infants and young children. Cochrane Database Syst Rev 2013; 2013: CD004878.
45. Orzołek I, Ambrożej D, Makrinioti H et al. Severe bronchiolitis profiling as the first step towards prevention of asthma. Allergol Immunopathol (Madr). 2023; 51: 99-107.
46. Fernandes RM, Wingert A, Vandermeer B. Safety of corticosteroids in young children with acute respiratory conditions: a systematic review and meta-analysis. BMJ Open. 2019; 9: e028511.
47. Silverman M, Sheffer A, Diaz PV et al. Outcome of pregnancy in a randomized controlled study of patients with asthma exposed to budesonide. Ann Allergy Asthma Immunol. 2005; 95: 566-70.
48. Liu X, Agerbo E, Schlünssen V et al. Maternal asthma severity and control during pregnancy and risk of offspring asthma. J Allergy Clin Immunol. 2018; 141: 886-92.
49. Galván CA, Guarderas JC. Practical considerations for dysphonia caused by inhaled corticosteroids. Mayo Clin Proc. 2012; 87: 901-4.
50. Pirożyński M, Florkiewicz E, Radzikowski K et al. Praktyczne aspekty nebulizacji u dorosłych z podstawami zasad dawkowania aerozoli leczniczych. In: ABC nebulizacji ze szczególnym uwzględnieniem dawkowania. Pirożyński M (ed.). Via Medica, Gdańsk 2015: 144-86.
51. Krenke K, Jackowska T, Mazurek H et al. Terapia nebulizacyjna budezonidem ? czynniki decydujące o efekcie terapeutycznym. Stanowisko ekspertów. Przegl Pediatr. 2024; 53: 29-39.
52. Fink JB, Stapleton KW. Nebulizers. J Aerosol Med Pulm Drug Deliv. 2024; 37: 140-56.
53. Sosnowski TR, Janeczek K, Emeryk A et al. Nebulizator siateczkowy z komorą inhalacyjną ? nowinka techniczna czy istotny postęp w nebulizacji? Terapia. 2022; 2: 64-8.
54. Alcoforado L Paiva DN, Ari A et al. Does valved holding chamber improve aerosol lung deposition with a jet nebulizer? A randomized crossover study. Pharmaceutics. 2022; 14: 566.