1. To remove the mouthpiece cover, hold between the thumb and forefinger, squeeze gently and pull apart as shown. Check inside and outside to make sure that the mouthpiece is clean, and that there are no foreign objects.
Testing Your Inhaler: If the inhaler is new or if it has not been used for three days or more, one puff should be released into the air to make sure that it works.
2. Hold the inhaler upright as shown, with your thumb on the base, below the mouthpiece. Breathe out as far as is comfortable.
3. Place the mouthpiece in your mouth between your teeth and close your lips around it but do not bite it.
4. Just after starting to breathe in through your mouth press down on the top of the inhaler to release a puff while still breathing in steadily and deeply
5. Hold your breath; take the inhaler from your mouth and your finger from the top of the inhaler.
Continue holding your breath for a few seconds or as long as is comfortable. Breathe out slowly.
6. If you are to take another puff, keep the inhaler upright and wait about half a minute before repeating steps 2 to 5.
7. After use always replace the mouthpiece cover to keep out dust and fluff. Replace firmly and snap into position.
Higher doses of inhaled beclomethasone (more than 1000 mcg/day) may result in more absorption into the body. This may decrease bone formation and increase bone breakdown (resorption), resulting in weak bones and a risk of fractures . Even higher doses (more than 1500 mcg/day in adults and 400 mcg/day in children) may suppress the adrenal glands and impair their ability to make natural glucocorticoid. Patients with such suppression (which can be identified by testing) need increased amounts of glucocorticoid orally or by the intravenous route during periods of high physical stress since higher amounts of glucocorticoids are needed by the body to fight physical stress.
Orally inhaled corticosteroids, including budesonide, may cause a reduction in growth velocity when administered to pediatric patients. A reduction in growth velocity may occur as a result of inadequate control of asthma or from use of corticosteroids for treatment. The potential effects of prolonged treatment on growth velocity should be weighed against the clinical benefits obtained and the risks associated with alternative therapies. To minimize the systemic effects of orally inhaled corticosteroids, including PULMICORT FLEXHALER, each patient should be titrated to his/her lowest effective dose (see PRECAUTIONS, Pediatric Use ).