Budesonide and formoterol

Easy-to-read medicine information about budesonide + formoterol – what is it, how to use budesonide + formoterol safely and possible side effects.

Type of medicine	Also called
This is a combination medicine. It contains a corticosteroid (budesonide) plus a bronchodilator (formoterol)	Symbicort^® Turbuhaler Vannair^® Inhaler budesonide + eformoterol

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 twice daily.
Turbuhaler: the usual dose is 1 inhalation once or twice daily. 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 for months or years.
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.

Spacers
Using an MDI with a spacer can make it easier to use the inhaler and also helps to get the medicine into the lungs. Spacers increase the effectiveness of your medicine. Children over 10 years may be able to use an MDI without a spacer; however, babies and young children must use MDIs with a spacer or a spacer and a mask. Read more about spacers.

How to use your Turbuhaler

How to use your Turbuhaler
(Health Navigator NZ & Auckland District Health Board, 2018) Using your Turbuhaler Unscrew and remove the cap. Hold the Turbuhaler upright. Turn the base as far as it will go and then back to the original position – listen for the click. Do not shake the inhaler. Sit upright and breathe out gently away from the inhaler. Insert the mouthpiece into your mouth, holding the inhaler horizontally, ensuring your lips are firmly sealed. Breathe in steadily and deeply. Hold your breath for about 10 seconds (count from 0 to 10). Remove the Turbuhaler from your mouth, then breathe out gently through your nose. Replace the cap securely. Rinse your mouth and spit out water after each use. Cleaning your Turbuhaler Do not allow the device to get wet when cleaning. Wipe the mouthpiece with a dry cloth. Do not wash the mouthpiece. 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. When a red mark or number appears, there are approximately 20 doses left.

(Health Navigator NZ & Auckland District Health Board, 2018)

Using your Turbuhaler

Unscrew and remove the cap.
Hold the Turbuhaler upright. Turn the base as far as it will go and then back to the original position – listen for the click. Do not shake the inhaler.
Sit upright and breathe out gently away from the inhaler.
Insert the mouthpiece into your mouth, holding the inhaler horizontally, ensuring your lips are firmly sealed.
Breathe in steadily and deeply. Hold your breath for about 10 seconds (count from 0 to 10).
Remove the Turbuhaler from your mouth, then breathe out gently through your nose.
Replace the cap securely.
Rinse your mouth and spit out water after each use.

Cleaning your Turbuhaler

Do not allow the device to get wet when cleaning. Wipe the mouthpiece with a dry cloth. Do not wash the mouthpiece. 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. When a red mark or number appears, there are approximately 20 doses left.

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.

Side effects	What should I do?
Change in voice (hoarse voice) Different taste in your mouth Dry mouth or throat Cough	These are quite common when you first start using your inhaler and usually goes away with time. Rinse your mouth after each use Tell your doctor if troublesome.
Signs of oral thrush (a fungal infection in the mouth) such as a very sore tongue, throat or mouth, with white sores on the tongue, or in the mouth	Tell your doctor or pharmacist
Feeling shaky Nervousness Tremor Headache Muscle cramps Problems sleeping	These are quite common when you first start using your inhaler and usually goes away with time. Tell your doctor if troublesome.
Changes in your heartbeat (faster) Chest pain Blurred vision or changes to your eyesight	Tell your doctor or ring HealthLine 0800 611 116

Learn more

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

References

Budesonide + formoterol New Zealand Formulary

Credits: Sandra Ponen, Pharmacist. Reviewed By: Angela Lambie, Pharmacist, Auckland Last reviewed: 07 Jun 2019 Page last updated: 18 Jun 2019