Inhaled Budesonide

Popular Brand Names:

Pulmicort Budelin Novolizer Easyhaler

Inhaled budesonide is a form of cortisone (corticosteroid), which was first approved in 1994. It is used globally for treating asthma and in some countries, it is also approved for treating chronic obstructive pulmonary disease (COPD).

Inhaled budesonide exerts powerful anti-inflammatory effects on bronchial and lung tissues. Researchers have also found that it directly inhibits replication of the SARS-CoV-2 virus, amongst its other mechanisms of action against COVID-19.

The origin of the idea to use inhaled budesonide for treating COVID-19 is unclear. In March 2020, early during the pandemic, a clinical trial using inhaled budesonide was registered at HÔPITAUX DE PARIS in France. In parallel, researchers Dr. Dan Nocolau of QUT in Brisbane, Australia, and Dr. Moa Bafahdel of Oxford University in the UK were surprised to notice that asthma and COPD patients using inhaled budesonide were less likely to become infected with SARS-CoV-2 or to develop COVID-19. They theorized that the regular use of inhaled budesonide by these patients was providing a protective effect against COVID-19.

A clinical trial at the University of Oxford enrolled 1,700 early COVID-19 patients. The study results clearly demonstrate the potential for inhaled budesonide to treat early COVID-19 in non-hospitalized patients. In April 2021 the British National Health Service published an interim position statement allowing physicians to prescribe inhaled budesonide to COVID-19 patients aged over 65 years or over 50 years if they suffered from a long-term health condition.

In May 2021 the Ministry of Health, Government of India added inhaled budesonide to its Clinical Management Protocol for COVID-19 in adults. They recommended prescribing it to patients who have persistent symptoms of fever and/or cough beyond 5 days from onset of disease. Their recommended dosing is 800 micrograms twice a day for 5 to 7 days.

Key Facts for Inhaled Budesonide

Description: Corticosteroid Inhaler
Year Approved: 1994
Approved Uses:

Asthma (US, UK)

Typical Dose Range: 180 - 2400 mcg / daily
Maximum Reported Safe Dose in Adults: 3200 mcg / daily
Populations of Use: Pediatric, Adult, Geriatric
Typical Duration of Use: Long Term
Further Drug Information:

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Inhaled Budesonide's Anti-COVID Properties

  • Anti-inflammatory
  • Downregulates gene expression of ACE2, the SARS-CoV-2 virus receptor on human cells
  • Downregulates levels of TMPRSS2, which aids SARS-CoV-2 spike protein binding to ACE2
  • Inhibits SARS-CoV-2 replication
  • Suppresses excessive Type I interferon

Published Medical Literature About Inhaled Budesonide’s Role in COVID

Access all Research

August 10, 2021 | Peer Reviewed: Yes | Publication Type: Original , Clinical Prospective

A clinical trial of inhaled budesonide in high-risk COVID-19 patients showed significantly faster recovery times, reduced hospitalizations and lower death rates.

Inhaled budesonide for COVID-19 in people at high risk of complications in the community in the UK (PRINCIPLE): a randomised, controlled, open-label, adaptive platform trial
August 2, 2021 | Peer Reviewed: No | Publication Type: Review/Commentary/Letter

A commentary explaining budesonide's potential in treating early COVID-19. Includes a graphical explanation of its mechanism of action.

Budesonide: A promising candidate therapeutic for early COVID-19
July 20, 2021 | Peer Reviewed: Yes | Publication Type: Original , Preclinical

Lab study demonstrates that budesonide directly suppresses the replication of SARS-CoV-2.

Antiviral Effect of Budesonide against SARS-CoV-2
July 5, 2021 | Peer Reviewed: Yes | Publication Type: Review/Commentary/Letter

Early treatment of COVID-19 is feasible using several different existing drugs, including budesonide. A review of the current research is provided.

Pharmacological Treatment of Patients with Mild to Moderate COVID-19: A Comprehensive Review

Videos Discussing Inhaled Budesonide’s Role in COVID

How and When to use Inhaled Budesonide in Covid-19 (Practical demonstration) – Dr Mahadev Desai

PlexusMD | May 8, 2021

Learn how to use Dry Powder Inhaler (DPI) and Metered Dose Inhaler (MDI) for inhalation of steroids (Budesonide) in mild Covid-19

Inhaled Steroid For Early COVID-19: Increased Clinical Recovery And Decreased Persistent Symptoms?

Whiteboard Doctor | May 2, 2021

Inhaled Budesonide, a steroid medication, for the treatment of early COVID-19. This new research study published in Lancet found that in early COVID-19 inhaled Budesonide may increase the probability of clinical recovery, decrease the risk for decompensation, and prevent persistence of symptoms (decrease the potential for Long Haulers?)

Study – Inhaled budesonide in the treatment of early COVID-19 (STOIC)

Drbeen Medical Lectures | April 15, 2021

Researchers in UK studied the effect of inhaled budesonide in outpatient setting for mild COVID patients. Researchers found out that the early use of inhaled budesnoid reduces the likelihood of needing urgent medical care and reduces time to recovery after early COVID.

Inhaled asthma drug may accelerate COVID-19 recovery time — study

UNTV News and Rescue | April 15, 2021

An anti-inflammatory medicine commonly used for asthma has been found to shorten the recovery time of COVID-19 patients and could potentially be used to treat patients early in their illness at home.

Can asthma inhalers prevent COVID-19 hospitalisations? The STOIC Study – Prof Mona Bafadhel

Oxford BRC | March 16, 2021

In this talk from 16 March 2021, Prof Mona Bafadhel discusses her recent research on the use of inhaled corticosteroids (usually used for asthma and COPD) to reduce the chances of severe respiratory illness in COVID-19 patients.

Nebulized Steroids (Budesonide) Talk with Dr. Richard Bartlett

Drbeen Medical Lectures | August 2, 2020

A full-length interview with Dr. Richard Bartlett, credited with discovery of inhaled budesonide for treating COVID-19.

Is there a “SILVER BULLET” for COVID-19?

Christy Risinger, MD | July 17, 2020

Discussion on Dr. Bartlet’s claim on budesonide’s effects

Clinical Trials of Inhaled Budesonide in COVID

July 16, 2021 | Community/Outpatient Based |

Prospective Randomized Study of the Treatment of Pediatric Patients That Lost Sense of Smell Due to COVID-19

Budesonide irrigations once a day by pouring 0.5mg/2ml of budesonide into a irrigation bottle with saline and irrigating the nose.

February 1, 2021 | Hospital-Based |

Phase IV, single-center, randomized and open-label study to evaluate the impact of early treatment with a combination of an inhaled corticosteroid and a long-acting ß2 adrenergic agonist (budesonide / formoterol) versus standard of care on the evolution of the disease in vulnerable patients with COVID-19: INHALAVID Trial

Hospital-based; no dose and frequency stated

October 23, 2020 | Community/Outpatient Based |

Inhalation Budesonide in the treatment of patients with mild Covid-19

Budesonide Rotacaps 200 mcg BD for 10 – 14 days depending on onset of symptoms given in addition to the local standard of care

May 15, 2020 | Community/Outpatient Based |

Use of inhaled corticosteroids as treatment of early COVID-19 infection to prevent clinical deterioration and hospitalisation – The STOIC Study (STerOids in COVID)

No dose and frequency stated

April 24, 2020 | Community/Outpatient Based |

A Randomized Controlled Trial Evaluating the Efficacy of Local Budesonide Therapy in the Management of Hyposmia in COVID-19 Patients Without Signs of Severity

Nasal irrigation with budesonide and physiological saline (Budesonide 1mg/2mL diluted in 250mL of physiological saline 9°/00): 3 syringes of 20mL in each nasal cavity, morning and evening, for 30 days, in addition to olfactory rehabilitation twice a day.

April 21, 2020 | Hospital-Based |

Treatment With Inhaled Corticosteroids in Patients Hospitalized Because of COVID19 Pneumonia

Adding budesonide to standard of care for pneumonia in COVID19 positive patients (no dose and frequency stated)

April 2, 2020 | Hospital-Based |

Evaluation of Efficacy of Pharmacotherapy Treatment of COVID- 19 Infection Using Oral Levamisole and Formoterol+Budesonide Inhaler and Comparison of This Treatment Protocol With Standard National Treatment of the Disease

Levamisole Pill + Budesonide+Formoterol inhaler
Levamisole 50 mg tablet has to be taken 1-2 tablets every 8 hours Budesonide+Formoterol has to be inhaled 1-2 puff every 12 hours

March 27, 2020 | Hospital-Based |

Protective role of inhaled steroids for COVID-19 infection – INHASCO

No dose and frequency stated