Budesonide and formoterol

What is budesonide + formoterol?

Budesonide and formoterol are mixed together in a Turbuhaler or an inhaler (puffer). The combination is used to treat the symptoms of asthma and COPD and to prevent them from recurring.

• Budesonide works by preventing the swelling and irritation in the walls of the small air passages in the lungs. It belongs to a group of medicines known as inhaled corticosteroids. It is also called a preventer (because when used every day it prevents asthma attacks).
• Formoterol works by relaxing and opening up the air passages and in that way makes breathing easier. 

If you have asthma and are using the SMART action plan, the budesonide + formoterol Turbuhaler (Symbicort) is both your preventer and reliever medicine. Read more about the SMART action plan.

In New Zealand, budesonide + formoterol inhalers are available in different brands, devices and strengths:

• Turbuhaler (a dry powder inhaler): Symbicort
• metered dose inhaler (MDI or puffer): Vannair

Using an inhaler device enables the medicine to go straight into your airways when you breathe in. This means that your airways and lungs are treated, but very little of the medicine gets into the rest of your body.

Both the MDI and Turbuhaler are effective inhaler devices. The choice of device is personal preference. Read more about the different inhaler devices and deciding on the right inhaler for you.

Dose

The dose of budesonide + formoterol will be different for different people depending on the severity of your symptoms and the strength of your MDI or Turbuhaler. The following are usual doses:

• MDI: the usual dose is 2 puffs two times a day.
• Turbuhaler: the usual dose is 1 inhalation once or two times a day. Some people may need lower doses. For example, once at night, if you have night-time symptoms or once in the morning if you have daytime symptoms.
• SMART action plan: your action plan will tell you how many doses of Symbicort to use and the maximum number of doses you should use in 24 hours. If you do not get relief from your symptoms after using your inhaler, you must contact your doctor for advice straightaway or call 111. Read more about the SMART action plan.

Tips

• Always use your inhaler exactly as your doctor has told you. The pharmacy label on your medicine will tell you how much to take, how often to take it and any special instructions.
• Budesonide + formoterol inhalers are available in different strengths. Ask your doctor or pharmacist what strength you are taking. If your inhaler looks different to what you were expecting, ask your pharmacist.
• Keep using your inhaler every day. Do not stop using it, even if you feel better. Since asthma and COPD are long-term conditions, prevention with budesonide and formoterol is ongoing and it will need to be used every day.
• Try to use your inhaler at the same time each day, to help you to remember to use it regularly.
• Budesonide can cause a sore throat and hoarse voice – rinse your mouth after each use to prevent this.
• If you miss a dose, you can take it as soon as you remember. But if it is nearly time for your next dose, just take your next dose at the right time.

How to use your MDI (puffer)

To get the most benefit, it is important to use the correct technique when using your inhaler. Ask your doctor, pharmacist, or nurse to explain how to use your inhaler. Even if you have been shown before, ask your doctor, pharmacist, or nurse to explain how to use your inhaler if you still have any questions. Here is some guidance.

How to use your MDI (puffer)
	Take off the cap and hold the inhaler upright.
	Shake the inhaler to mix the medication.
	Sit upright, tilt your head back slightly (as if you are sniffing) and breathe out gently.
	Hold the device upright, insert the inhaler into your mouth, ensuring that your lips firmly seal the mouthpiece. At the beginning of a slow, deep breath, breathe in through the mouthpiece as you press the inhaler to release one dose or 'puff'.
	Breathe in fully, remove the inhaler from your mouth and hold your breath for 10 seconds or as long as is comfortable. Breathe out gently through your nose.

Using a spacer with your inhaler

A spacer is an attachment to use with your MDI. Using a spacer with your MDI makes it easier to use the inhaler and helps to get the medicine into your lungs, where it’s needed (with less medicine ending up in your mouth and throat). Spacers improve how well your medicine works. Read more about spacers.

How to use your Turbuhaler

Using your turbuhaler

• Open: unscrew and remove the cap. Hold the turbuhaler upright.
• Load the dose: twist the base anticlockwise and then back in the other direction until you hear a click. Your turbuhaler is now loaded with one dose of medicine
• Breathe out: breathe out, away from the turbuhaler. Do not blow directly into the turbuhaler.
• Inhale your dose: place the mouth piece in your mouth and form a seal with your lips. Breathe in deeply. Remove the turbuhaler and hold your breath for up to 10 seconds.
• Close: replace the cap and twist until it is on properly.

Cleaning and storing your turbuhaler: wipe the mouthpiece with a clean dry tissue. Do not wash the mouthpiece or allow it to get wet when cleaning. Keep the cap on when not in use. The device may clog if exhaled or dribbled into or if stored in an area of high humidity with the cap off or unsealed.

When to start a new turbuhaler: there is a window under the mouthpiece on the outside of the turbuhaler called a dose indicator window. When it turns red it is time to get a new turbuhaler. 

Precautions – before using budesonide + formoterol 

• Are you breastfeeding?
• Are you lactose intolerant?
• Have you ever had pulmonary tuberculosis (TB)?
• Do you have heart disease?
• Do you have an overactive thyroid (hyperthyroid)?
• Do you have high blood pressure (hypertension)?
• Do you have an irregular heartbeat or rhythm, including a very fast pulse?
• Do you play competitive or professional sport?

If so, it’s important that you tell your doctor or pharmacist before you start using budesonide + formoterol. Sometimes a medicine isn’t suitable for a person with certain conditions, or it can only be used with extra care.

Possible side effects

Like all medicines, budesonide + formoterol can cause side effects, although not everyone gets them. Often effects improve as your body adjusts to the new medicine.

Learn more

budesonide and formoterol New Zealand Formulary Patient Information
Symbicort; Vannair Medsafe Consumer Information Sheets

References

1. Budesonide + formoterol New Zealand Formulary