Symbicort

Also called budesonide and formoterol

Symbicort is used to treat the symptoms of asthma and COPD and to prevent them from recurring. Find out how to take it safely and possible side effects.

What is Symbicort?

Symbicort is a combination of 2 medicines, budesonide and formoterol, in a single inhaler. Symbicort is used to treat the symptoms of asthma and COPD and to prevent them from recurring.

  • Budesonide is a corticosteroid. When inhaled, it prevents swelling and irritation in the walls of the small air passages in your lungs. It is also called a preventer, because when used every day it prevents shortness of breath and wheezing.
  • Formoterol is a long-acting, fast onset bronchodilator. It relaxes and opens up your air passages, making breathing easier. 

In New Zealand, Symbicort is available in different strengths: Symbicort 100/6, Symbicort 200/6 and Symbicort 400/12.

Symbicort has different uses

COPD

If you are using Symbicort for COPD, it must be used regularly twice a day every day as a preventer. Read more about medicines for COPD.

Asthma

If you are using Symbicort for asthma, it can be prescribed in three different ways:

  • regular preventer (and using a different inhaler as a reliever such as salbutamol)
  • regular preventer plus also using the same inhaler as a reliever when needed*
  • reliever only without also taking it as a preventer.* 

The choice between these three options should be discussed with your doctor, and is based on the severity of your symptoms.
*Note: The high dose 400/12mcg strength Symbicort cannot be used as a reliever.

Mild asthma

If you have mild asthma, you can simply use one puff of Symbicort Turbuhaler as a reliever when needed for shortness of breath, without needing to use it regularly. This is called AIR therapy (anti-inflammatory reliever therapy). 

Moderate to severe asthma

If you have moderate to severe asthma, you can use your Symbicort Turbuhaler as both a preventer and and also as a reliever. This is called SMART (which stands for single maintenance and reliever therapy). This means that you can use your Symbicort Turbuhaler regularly each day for symptom prevention, and also when needed for symptom relief.

Preventer: Use Symbicort every day, once or twice daily.
Reliever: One inhalation when needed for shortness of breath. You can repeat as required, up to a maximum of 12 inhalations in one day. If you do need to take more and more doses each day, see your doctor to assess your therapy. Read more about the SMART action plan.

Tips for when using the Symbicort Turbuhaler

  • 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.
  • Symbicort Turbuhalers are available in different strengths. Ask your doctor or pharmacist which strength you are taking. If your inhaler looks different to what you were expecting, ask your pharmacist about this.
  • Rinse your mouth after each use. Symbicort can cause a sore throat and hoarse voice. Rinse your mouth after each use to prevent this.

How to use your Symbicort Turbuhaler

To get the most benefit, it is important to use the correct technique when using your Symbicort. Ask your doctor, pharmacist or nurse to explain how to use your Turbuhaler. 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.

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

 

Using your Turbuhaler
 How to use your  Symbicort 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 1 dose of medicine.
  Breathe out: Breathe out, away from the Turbuhaler. Do not blow directly into the Turbuhaler.
  Inhale your dose: Place the mouthpiece 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's time to get a new Turbuhaler. 

Precautions – before using Symbicort

  • Are you pregnant or 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 diabetes?
  • 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 Symbicort. Sometimes a medicine isn’t suitable for a person with certain conditions, or it can only be used with extra care.

Side effects

Like all medicines Symbicort can cause side effects, although not everyone gets them. Often side 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 go away with time. 
  • Rinse your mouth after each use
  • Tell your doctor if troublesome.
  • Signs of oral thrush (a fungal infection in your mouth) such as a very sore tongue, throat or mouth, with white sores on your tongue or in your 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 go away with time. 
  • Tell your doctor if troublesome.
  • Changes in your heartbeat (faster)
  • Chest pain
  • Sudden changes in mood
  • Blurred vision or changes to your eyesight
  • Tell your doctor or phone Healthline 0800 611 116.

Learn more

Budesonide and formoterol NZ Formulary Patient Information
Symbicort Medsafe Consumer Information Sheets, NZ

References

  1. Budesonide + formoterol NZ Formulary
Credits: Sandra Ponen, Pharmacist. Reviewed By: Angela Lambie, Pharmacist, Auckland Last reviewed: 16 Feb 2021