1. Section Editor(s): Cohen, Michael R. RPh, MS, ScD

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AstraZeneca has received approval to update the patient instructions on its Pulmicort Flexhaler (budesonide inhalation powder), thanks to nurses' reports on patient confusion with the device's dose counter.


The number in the device's dose-counter window doesn't visibly move with each administered dose. Patients will see that the counter has advanced only after receiving about five doses. Because patients didn't see the dose counter moving, many thought they weren't getting any medication with the first actuation of the inhaler, leading them to take extra doses. The new patient instructions in the product labeling provide more detailed information about how the dose counter works.

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If you're caring for a patient who uses this inhaler, teach him how the dose counter works and have him demonstrate using it. An updated patient-information leaflet is available at