Aerobid Corticosteroid

1 What is Aerobid Corticosteroid?

Brand: Aerobid, Aerobid-M, Alvesco, Arnuity Ellipta, Asmanex HFA, Asmanex Twist, Azmacort, Beclovent, Flovent, Pulmicort Turbuhaler, Qvar, Flovent Diskus, Flovent HFAas

Generic: Inhalation corticosteroids

Inhalation corticosteroids are used to help prevent asthma symptoms, similar to cortisone medications. When used on a daily basis, the inhalation of corticosteroids decrease the number and severity of asthma attacks. However, these medications will not stop an asthma attack that has already started.

These medications work by preventing certain cells in the lungs and breathing passages from releasing the substances that cause asthma symptoms.

Inhaled corticosteroids may be used alongside other asthma medications such as bronchodilators (medications that expand narrowed breathing passages) or other oral corticosteroids.

These medications are available only through your doctor’s prescription.

This product is available in the following forms:

  • Aerosol Liquid
  • Aerosol Powder
  • Capsule
  • Spray
  • Suspension
  • Powder
  • Solution
  • Disk

2 What to Know Before Using

As with all medicines, the risks must be compared to how much a medication will help you. This is a decision that you and your doctor will make together. For this medication, there are many things that need to be considered:

Allergies

Inform your doctor if you have ever had an allergic reaction to doxorubicin or to any other medications. It is also important to inform your doctor of any non-medicine allergies such as foods, dyes, preservatives or animals.

Pediatric

Inhalation corticosteroids have been tested in children. Aside for the possibility of delayed growth, no side efects or problems have been shown in low effective doses.

Up-to-date studies have shown that delayed growth or reduced adrenal gland function may occur in some children using this medication in normal doses. However, uncontrolled asthma may cause delayed growth, especially when oral corticosteroids are needed. Your doctor will want to try the lowest dose of an inhaled corticosteroid to control the asthma. This will reduce the chance of delayed growth or an effect on the adrenal gland. It is important for children taking inhaled corticosteroids to have their growth monitored by a doctor.

Regular use of this medication may allow some children to reduce the amount of oral corticosteroids. This will also reduce the risk of delayed growth or reduced adrenal function.

Children who are using this medication in large doses should avoid exposure to chicken pox or measles. If the child is exposed or develops chicken pox or measles, you should contact your doctor immediately.

Geriatric Usage

No up-to-date studies have been performed in the elderly population. However, no problems specific to the elderly have been documented.

Pregnancy

Studies in animals have shown that this medication may cause birth defects and other problems. However, when used in regular daily doses, no problems in regards to the unborn child have been documented in humans. Corticosteroids may prevent the effects of uncontrolled asthma, which are known to be harmful to unborn children. Be sure to inform your doctor if you are pregnant or think you may be pregnant before taking this medication.

Breastfeeding

It is unknown whether or not this medication passes into breast milk. Mothers who are using this medication and wish to breast feed should discuss this with their doctor.

Drug Interactions

Certain medications should not be used together. However, in certain cases, two medications may be used together, even if an interaction might occur. In these cases,your doctor may want to change your dose or take other precautions. Tell your doctor if you are taking any other prescription or over-the-counter medications.

Other Interactions

Certain medications should not be used while eating, or while eating certain foods in case of negative interactions. Using alcohol or tobacco with certain medications.

Other Medical Problems

Pre-existing medical problems may affect the use of inhaled corticosteroids. Make sure you inform your doctor about any other medical problems, especially:

  • Acute asthma attacks (status asthmaticus) - Triamcinolone should not be used in patients with this condition.
  • Liver disease (cirrhosis) - The effects of this medication may be stronger in patients with this disease
  • Glaucoma - Use with caution. May increase the pressure in the eye
  • Hypothyroidism (decreased production of thyroid hormone) - The effects of this medication may be stronger in patients with this condition.
  • Untreated infections (i.e. bacteria, fungal, viral) - Use with caution. May make this condition worse.
  • Osteoporosis (bone disease) - This medication in high doses may make this condition worse in women who are past menopause and who are not receiving an estrogen replacement.
  • History of, or current tuberculosis-Use of this medication may cause a tuberculosis infection to occur.

May also cause negative interactions. Talk with your doctor about the use of your medication with food, alcohol or tobacco.

3 Proper Usage

This medication will not relieve symptoms of an asthma attack that has already started. Despite this, your doctor may still want you to take this medication at the usual time, even if you use another medication to relieve the asthma attack.

Only take this medication as directed by your doctor. Do not take more, less or for a longer or shorter period of time than your doctor tells you. This medication works best if there is a constant amount in the blood. To help keep this amount constant, do not miss any doses and take the medication at the same time each day.

This medication must be used every day at regular intervals in order to help prevent asthma attacks. It may take 4-6 weeks for you to notice an improvement in your condition, and several months before you feel the full effects of this medication. If you are taking other medications for your asthma, this may not take as long.

Gargling and rinsing your mouth with water after taking this medication may help prevent hoarseness, throat irritation and infection in the mouth. Your doctor may also want you to use a spacer device (long tubes to slow the delivery of medication) to lessen these problems.

This medication is used with a special inhaler and should come with patient directions. Ask your doctor about anything you do not understand.

For patients using inhaled beclomethasone, flunisolide or triamcinolone:

If you have not used your inhaler for a while, or this is your first time using, you need to prime it may not deliver the right amount of medication at first.

To test or prime inhalers, use the following directions:

  • Insert the metal canister into the mouthpiece, following the manufacturer’s instructions.
  • Shake the inhaler 3-4 times and remove the cover of the mouthpiece.
  • Hold the inhaler away from you and press the top of the canister twice to spray the medication into the air. The inhaler will now provide you with the appropriate amount of medication.

To use most inhalers:

  • Hold the inhaler upright with the mouthpiece end down and pointing towards you.
  • Gently shake the inhaler 3-4 times and remove the mouthpiece cover.
  • Exhale normally, then use one of the following methods recommended from you doctor:
  1. Open-mouth method - Place the mouthpiece 1-2 inches in front of your widely opened mouth. Aim the inhaler so that the medication does not spray onto the roof of your mouth or your tongue.
  2. Closed-mouth method - Place the mouthpiece between your teeth and close your lips. Do not block the mouthpiece with your tongue.
  • Breathe in slowly through your mouth and press the top of the canister once. Continue to breath in slowly for 3-5 seconds. It is important to press the canister and inhale at the same time to make sure the medication gets to your lungs.
  • Hold your breath for as long as you can to give the medication time to settle in your lungs.
  • Remove the inhaler from your mouth and exhale slowly.

If your doctor has instructed you to take more than one dose of medication at once, gently shake the inhaler and repeat the steps for each dose you need. Press the canister once for each dose of medication.

Your doctor may want you to use a spacer device with your inhaler. This helps get the medication to your lungs and reduces the amount of time that the medication stays in your mouth and throat.

To use a spacer device:

  • Attach the spacer to your inhaler by following the manufacturer’s instructions.
  • Gently shake the inhaler 3-4 times.
  • Exhale slowly and place the spacer’s mouthpiece between your teeth and close your lips.
  • Breathe in slowly through your mouth and press the top of the canister once. Continue to breath in slowly for 3-5 seconds. It is important to press the canister and inhale at the same time to make sure the medication gets to your lungs.
  • Hold your breath for as long as you can to give the medication time to settle in your lungs.
  • Remove the inhaler from your mouth and exhale slowly.

If your doctor has instructed you to take more than one dose of medication at once, gently shake the inhaler and repeat the steps for each dose you need. Press the canister once for each dose of medication.

Clean the mouthpiece and spacer (if used) at least once a week. Remove the canister and wash the inhaler with warm, soapy water before rinsing the remaining soap off. Let the inhaler air-dry completely before putting the canister back into the inhaler.

For patients using beclomethasone capsules for inhalation:

Do not swallow the capsules! The medication will not work if swallowed.

To use the inhaler:

  • Do not insert the capsule into the inhaler until you are ready to use this medication.
  • Twist the barrel of the inhaler until it stops.
  • Take a capsule from the container. Press the capsule, clear end first, into the small, raised hole. Make sure the top of the capsule is even with the top of the hole.
  • Hold the inhaler on its side with the white dot facing up and twist the barrel until it stops. This breaks the capsule in half so you can inhale the powder.

To use the inhaler:

  • Exhale slowly and place the spacer’s mouthpiece between your teeth and close your lips.
  • Breathe in slowly through your mouth and press the top of the canister once. Continue to breath in slowly for 3-5 seconds. It is important to press the canister and inhale at the same time to make sure the medication gets to your lungs.
  • Hold your breath for as long as you can to give the medication time to settle in your lungs.
  • Remove the inhaler from your mouth and exhale slowly.
  • If your doctor tells you to take a second capsule, follow the same steps used for the first capsule.
  • When you are finished using the inhaler, pull the two halves of the container apart and discard the empty capsule shells. Put the inhaler back together and place it back into its container.
  • Clean the inhaler at least twice a week with warm, soapy water before rinsing the remaining soap off. Let the inhaler air-dry completely before putting the canister back into the inhaler. The inhaler should be replaced every six months.

For patients using beclomethasone powder for inhalation:

To load the inhaler:

  • Do not insert the cartridge until you are ready to use this medication.
  • Take the brown mouthpiece off and hold the white cartridge by the corners and pull out until you see the ribbed sides. Squeeze the ribbed sides and take out the cartridge from the inhaler.
  • Place the disc holding the medication onto the white wheel with the numbers facing up. The underside of the disk should fit into the holes of the wheel.
  • Slide the cartridge back into the inhaler. Gently push the cartridge in and pull it back out. This will cause the disk to turn.
  • Continue this until the number 8 appears in the indicator window. Each disk contains eight doses. The window will show you how many doses you have left after each use.
  • To replace an empty disk with a full one, follow the same loading steps. Be sure you do not throw away the wheel when you discard the empty disk.

To use the inhaler:

  • Hold the inhaler flat in your hand and lift the rear edge up until the lid is fully upright.
  • The plastic needle on the front of the lid will break the compartment containing one dose of medication. Once the lid is fully raised, both the upper and lower surfaces of the compartment will be pierced. Do not lift the lid if there is no cartridge in the inhaler. This will break the needle.
  • Place the mouthpiece between your teeth and close your lips, tilting your head back slightly. Do not cover the air holes on the side of the mouthpiece and do not block the mouthpiece with your tongue.
  • Inhale as fast as you can until you have taken a full breath. Hold your breath as long as you can and remove the mouthpiece. This gives the medication time to settle in your lungs.
  • Exhale and resume breathing normally. Prepare the cartridge for your next dose. Pull out the cartridge once and push it back in. The disk will turn to the next numbered dose in the indicator window. Do not pierce the next compartment until your next dose.

To clean the inhaler, brush away the loose powder every day with the provided brush. The inhaler should be replaced every six months.

For patients using budesonide powder for inhalation:

To prime the inhaler:

  • Unscrew the cover of the inhaler and lift it off. Hold the inhaler with the brown piece pointing down. Turn the brown piece as far as it will go, then twist it back until it clicks. Repeat this step once and the inhaler will be primed.
  • Prime each new inhaler before use. After it has been primed once, it does not need to be primed again, even after it has gone unused for a long period of time.

To load the inhaler:

  • Unscrew the cover of the inhaler and lift it off. Turn the brown piece as far as it will go, then twist it back until it clicks.

To use the inhaler:

  • Place the mouthpiece between your teeth and close your lips, tilting your head back slightly. Do not block the mouthpiece with your tongue.
  • Inhale quickly until you have taken a full breath. Hold your breath as long as you can and remove the mouthpiece. This gives the medication time to settle in your lungs.
  • Exhale and resume breathing normally. Replace the cover of the mouthpiece to keep it clean.
  • This inhaler delivers a very fine powder, so you may not be able to taste, smell or feel this medication. This inhaler should not be used with a spacer.
  • When the indicator window shows a red mark, there are approximately 20 doses left. The inhaler will be empty when the red mark covers the window.

For patients using budesonide suspension for inhalation:

  • This medication is to be used in a power-operated nebulizer with a face mask or mouthpiece. You doctor will tell you which nebulizer to use. Make sure you understand how to use a nebulizer. If you have any questions, be sure to ask your doctor.
  • Any opened ampul needs to be protected from light. The medication in an open ampul must be used quickly after the ampul is open. Ampuls should be used within 2 weeks after the envelope that contains them is opened.
  • To prepare the medication for use in the nebulizer:
  • Remove one ampul and shake it gently. Open it by twisting off the wing.
  • Squeeze the contents of the ampul into the cup of the nebulizer. If you are only using half of the ampul, add enough of the provided sodium chloride to dilute the solution.
  • Gently shake the nebulizer, then attach the face mask to the nebulizer and connect the nebulizer to the air pump.

To use the medication in the nebulizer:

  • This medication should be inhaled over a time-period of 10-15 minutes.
  • Breathe slowly and evenly until the mist in the nebulizer is gone.
  • Rinse your mouth after the treatment. If you used a face mask, wash your face.

To clean the nebulizer:

The nebulizer needs to be cleaned after each treatment. Wash the cup of the nebulizer and the mask or mouthpiece in warm water with a mild detergent. Let the parts air-dry before putting them back together.

Dosing

Different patients will be given a different dose
of this medication based on the strength of the medication. The number of doses you take each day, the time between doses and the length of time you take this medication depends on the reason you are taking this medication. The following information only includes the average dose of this medication. If your dose is different, do not change it without first speaking to your doctor.

For beclomethasone:

  • For inhalation aerosol:

Adults and children 12 years of age and older:

  • For the 42mcg- or 50mcg-per-metered-spray products - two doses 3-4 times a day or four doses twice a day. Your doctor may want you to take a higher dose if you have more severe asthma.
  • For the 84mcg-per-metered-spray products - two doses twice a day.Your doctor may want you to take a higher dose if you have more severe asthma.

Children 6-12 years of age:

  • For the 42mcg- or 50mcg-per-metered-spray products - 1-2 doses 3-4 times a day or four doses twice a day.
  • For the 84mcg-per-metered-spray products - two doses twice a day.

Children up to 6 years of age - Use and dose must be determined by your doctor.

For capsules or powder for inhalation:

For bronchial asthma:

  • Adults and teenagers 14 years and older - Start at 200mcg 3-4 times a day. Your doctor may reduce the dose based on your condition.
  • Children 6-14 years of age - Start at 100mcg 2-4 times a day. Your doctor may reduce the dose based on your condition.
  • Children up to 6 years of age - Use and dose must be determined by your doctor.

For beclomethasone dipropionate HFA:

  • For inhalation aerosol (for bronchial asthma):

Adults and children 12 years of age and older:

  • For the 40mcg-per-metered-spray products - 1-4 doses twice a day.
  • For the 50mcg-per-metered-spray products - 1-2 doses twice a day if you have mild asthma. 2-5 doses twice a day if your asthma is more severe.
  • For the 80mcg-per-metered-spray products - 1-2 doses twice a day.
  • For the 100mcg-per-metered-spray products - 3-4 doses twice a day.

Children 5-11 years of age - 40mcg (one dose) twice a day.

Children up to 5 years of age - Use and dose must be determined by your doctor.

For budesonide:

For powder used for inhalation (for bronchial asthma):

  • Adults - 200-800mcg twice a day. A lower dose of 200-400mcg once daily in the morning or evening may be used for mild to moderate asthma when symptoms are well controlled. Your doctor may increase your dose depending on your condition.
  • Children 6 years of age and older - Start with 200mcg twice a day. Your doctor may increase the dose to 400mcg twice a day depending on your condition.
  • Children up to 5 years of age - Use and dose must be determined by your doctor.

For suspension for inhalation (for bronchial asthma):

  • Adults and children 8 years of age and older - 1,000-2,000mcg mixed with sterile sodium chloride solution for inhalation (approximately 2-4mL). This solution is used in a nebulizer for 10-15 minutes. This medication should be used twice a day.
  • Children 12 months to 8 years of age - 250-500mcg mixed with sterile sodium chloride solution for inhalation (approximately 2-4mL). This solution is used in a nebulizer for 10-15 minutes. This medication should be used twice a day.
  • Children up to 12 months of age - Use and dose must be determined by your doctor.

For flunisolide:

For inhalation aerosol (for bronchial asthma):

  • Adults and children 4 years of age and older - 500mcg twice a day (morning and evening).
  • Children up to 4 years of age - Use and dose must be determined by your doctor.

For triamcinolone:

For inhalation aerosol (for bronchial asthma):

  • Adults and children older than 12 years of age - Start at 150mcg (2 doses) 3-4 times per day or 300mcg (4 doses) twice a day. Your doctor may raise or reduce the dose based on your condition. However, you should not be taking more than 1,200mcg per day.
  • Children 6-12 years of age - Start at 75-150mcg (1-2 doses) 3-4 times a day or 150-300mcg (2-4 doses) twice a day. Your doctor may raise or reduce the dose based on your condition. However, you should not be taking more than 900mcg per day.
  • Children below 6 years of age - Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose of this medication, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and resume your normal dosing schedule. Do not take two doses at once.

Storage

Keep out of the reach of children.

Store the medication in a closed container at room temperature. Keep it away from heat, moisture and direct light. Do not freeze.

The 84mcg-per-metered-spray products of beclomethasone should not be stored for longer than 6 months after being removed from its moisture-protective pouch. Any remaining medication after 6 months should be thrown away.

Do not puncture, break or burn the aerosol container, even after it is empty.

4 Precautions to Take

It is very important that your doctor checks in with the you often while you are receiving this medication to make sure that it is working properly.

Check with your doctor if any of the following occur:

  • You go through a period of unusual stress on your body, such as surgery, injury or illness.
  • You have an asthma attack that does not improve after taking a bronchodilator medication.
  • You are exposed to a viral infection such as chickenpox or measles.
  • Signs of infection occur, especially in your mouth, throat or lungs.

It is recommended that you carry a medical ID card stating your condition and the medication you are using, as well as directions in case of an emergency.

Before you have any kind of surgery or emergency treatment, tell the doctor in charge that you are using this medication.

For patients regularly taking a corticosteroid in tablet or liquid form:

  • Do not stop this medication without consulting your doctor, even if your asthma seems to be improving. Your doctor may want you to slowly reduce the dose you are taking before stopping completely to reduce the chance of unwanted side-effects.
  • If your doctor tells you to reduce the dose or stop taking this medication by mouth, follow the directions carefully, as your body may need time to adjust. The length of time depends on the dose you were taking and how long you took it. It is very important that your doctor checks your progress at regular visits during this time. Ask your doctor for special directions you should follow if you have a severe asthma attack, if you need any other treatment or if certain side-effects occur. Make sure you follow these directions carefully.

5 Potential Side Effects

A medication may produce unwanted affects along with the intended effects. Although not all of these side-effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if you experience any of the following side-effects:

Rare:

  • Shortness of breath, difficulty breathing, chest tightness or wheezing
  • Signs of hypersensitivity reactions, such as swelling in the face, lips or eyelids

Less common:

  • Burning or pain during urination, blood in the urine or frequent urge to urinate (polyuria)
  • Chest pain
  • White, curd-like patches in the mouth or throat and/or pain while eating or swallowing
  • Dizziness or vertigo
  • General sense of discomfort or illness (malaise)
  • Irregular or fast heartbeat (palpitations, tachycardia)
  • Itching, rash or hives
  • Sinus problems
  • Stomach or abdominal pain
  • Swelling of the fingers, ankles, feet or lower legs
  • Unusual fatigue or weakness
  • Weight gain

Rare:

  • Bleeding from the rectal area or blood in the stool
  • Blurred vision or other changes in vision
  • Diarrhea or nausea
  • Fainting (syncope) or feeling faint
  • Fever
  • Frequent urination (polyuria) or unusual thirst (polydipsia)
  • Inhibited growth in children
  • High blood pressure (hypertension)
  • Increased fat deposits in the face, neck and trunk
  • Increased skin pigmentation
  • Loss of appetite
  • Menstrual changes
  • Mood or mental changes
  • Numbness
  • Pain or burning in the chest
  • Vomiting

Additional side effects may occur if you take this medication for a long period of time. Some side effects that occur do not normally need medical attention. These may disappear during treatment as your body adjusts to the medication. Ask your doctor about ways to prevent or reduce some of these side effects.

Inform your doctor if any of the following side effects continue or bother you, or if you have any questions:

More common:

  • Cold-like symptoms
  • Cough
  • Dry mouth or throat
  • Headache
  • Sort throat, hoarseness or voice change

Less common or rare:

Other side effects may occur in some patients that are not listed. If you notice any other side effects, check with your doctor.

Call your doctor for advice about side effects.

You may report side effects to the FDA at 1-800-FDA-1088.

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