Budesonid – oral inhalation

Additional information

Some studies suggest that there are sex differences in expression and diagnosing of asthma, and it has been discussed whether women are under-treated for respiratory diseases or not [5, 6].

Pharmacokinetics and dosing

According to population pharmacokinetic studies conducted by the manufacturer, no differences in pharmacokinetics have been identified due to sex or age for inhalation of budesonide [7]. Persons with lower body weight may have higher bioavailability of budesonide [8].

Effects

A large cohort study (520 men, 680 women) investigated the impact of sex and age on response to asthma therapy (including salbutamol, salmeterol, inhaled budesonide, zafirlukast, montelukast, beclomethasone and inhaled corticosteroids). There was no difference between men and women in treatment failure for any individual therapy. Individuals aged 30 years and older were more likely to have treatment failure but the risk was similar for men and women [9].Results from controlled clinical trials conducted by the manufacturer showed similar symptom reduction to budesonide suspension in both boys and girls aged 1-8 years [7].

Adverse effects

In a study of patients with asthma on inhaled budesonide and beclomethasone (12 men, 18 women), a significant decrease in BMD at the hip and lumbar spine was seen in premenopausal women but not in men, when compared to healthy subjects [10].

Reproductive health issues

Regarding teratogenic aspects, please consult Janusmed Drugs and Birth Defects (in Swedish, Janusmed fosterpåverkan).

Other information

In a study on inhalation technique using metered dose inhalers (33 men, 26 women), 75% of the participants had an incorrect inhalation technique, especially women, regardless of age. Only 4% of women and 43% of men had an acceptable inhalation technique. The authors speculate that this may add to the worse asthma prognosis in women, shown in a meta-analysis of six trials of randomly assigned asthma treatment [1].

Several studies have shown worse prognosis for women with asthma. In an observational registry study (416 men, 498 women), women were found to have more asthmatic symptoms, worse quality of life and require more health care due to their asthma [2]. In a Danish prospective study on hospitalization due to asthma (6104 men of whom 2.5% had asthma, 7436 women of whom 2.2% had asthma), women had a 1.7 higher relative risk to be hospitalized [3]. An observational study from Singapore found hospitalization due to asthma to be more common in boys than girls aged 0-4 years (boys/girls ratio 1.69). In adults aged 35-64 years, women were more hospitalized (men/women ratio 0.81) [4]. In a Japanese survey of adult patients receiving inhaled fluticasone, budesonide or beclomethasone (in total 1017 men, 1118 women), budesonide was more frequently prescribed to young women (59%) than men [11].