Level of control (Columns 2 to 4) is based on the most severe component of impairment (symptoms and functional limitations) or risk (exacerbations). Assess impairment by patient's or caregiver's recall of events listed in Column 1 during the previous 2 to 4 weeks and by spirometry and/or peak flow measures. Symptom assessment for longer periods should reflect a global assessment, such as inquiring whether the patient's asthma is better or worse since the last visit. Assess risk by recall of exacerbations during the previous year and since the last visit. Recommendations for adjusting therapy based on level of control are presented in the last row.
Pulmicort (budesonide) can come in solution which for asthma is then inhaled by using a nebulizer machine to aerosolize the medication. Swallowed Pulmicort (budesonide) is combined with other components such as Splenda to create a slurry which is then swallowed. This Swallowed budesonide (Pulmicort) Slurry may be used for those who may have more difficuly with dry swallowing fluticasone from an MDI. For those who are on swallowed steroids it is recommended not to eat or drink anything for 30 minutes after taking this medication so that it can provide optimal coating of the esophagus. Furthermore, anyone on these medications should swish and spit or brush their teeth after each use to remove any residual steroids in the mouth where it may have unwanted side effects.
Also, when given in very large doses (many puffs from a high-concentration steroid inhaler), the amount of steroid medicine that spills over into the bloodstream can become significant. Although the effect is small, like a very small dose of prednisone, over the years this small effect can potentially add up to serious harmful effects. High doses of inhaled steroids taken for a long time can probably predispose to cataracts, glaucoma, and thinning of the skin and bones. As a result, your doctor will probably only have you take high doses of inhaled steroids as a means to avoid steroid tablets. And he/she will constantly work with you to attempt to reduce the dose of inhaled steroids to a more conventional and safer range.