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.
Despite these legitimate concerns, I think the FDA was reassured by the experience other countries have had with OTC INS. If used as directed the potential for significant complications is very low. I’m hopeful that other molecules with better risk/benefit ratios will come to market and that competition will result in cost savings for patients while creating added convenience. When that day arrives, allergists and other physicians will still have an important role in counseling patients as to which OTC INS are best for them, much like we do for OTC antihistamines.