Table of ContentsView AllTable of ContentsUsesBefore UseDosageSide EffectsWarnings and Interactions
Table of ContentsView All
View All
Table of Contents
Uses
Before Use
Dosage
Side Effects
Warnings and Interactions
Symbicort is acombination inhalerused to controlasthmaand to maintain airflow in people withchronic obstructive pulmonary disease (COPD). It contains aninhaled corticosteroidcalled budesonide that helps alleviate airway inflammation and a long-actingbronchodilatorcalled formoterol fumarate dihydrate that helps keep airways open.
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Symbicort is not used as arescue inhalerbut rather provides long-term control of obstructive airway diseases like asthma and COPD. While safe, convenient, and effective, Symbicort is not appropriate for everyone.
Difference Between Asthma and COPD
Symbicort is approved for adults and children 6 years of age and over.
Each of the drugs contained in Symbicort has a distinct effect on the airways:
These effects are beneficial to people with reversible obstructive airways diseases, reducing thehyperresponsivenessthat triggersairway spasmsand alleviatingbronchoconstrictionthat impedes airflow out of the lungs.
Asthma is considered a reversible obstructive disorder because symptoms can be alleviated and breathing normalized with little long-term harm to the airways.
COPD is only partially reversible in that airway damage tends to progress even with treatment. Even so, combination inhalers like Symbicort can slow the disease progression even in those with advanced disease.
Off-Label Uses
On rare occasions, healthcare providers have been known to prescribe combination inhalers like Symbicort to treat severe or recurrentbronchitisunrelated to COPD.
Pros and Cons of Bronchodilators and Inhaled Steroids
Symbicort is typically prescribed when more conservative therapies fail to provide relief of asthma or COPD. The indications for each disease are different.
In asthma, this typically is inadequate control ofsymptoms, usually defined as a need to use a rescue inhaler more than twice a week.In such instances, a daily inhaled corticosteroid may be prescribed on its own, after which a LABA may be added if needed. LABAs are never used on their own to treat asthma.
Many health authorities, including the Global Initiative for Asthma (GINA), recommend combining inhaled corticosteroids and LABAs at the start rather than taking a stepped approach to asthma treatment.
How Asthma Is Treated
With COPD, the indications are slightly different. According to theGlobal Initiative for Chronic Obstructive Lung Disease (GOLD), the combined use of an inhaled corticosteroid and LABA is reserved for people with severe COPD (defined as two or moreexacerbationsor one or more hospitalizations per year). Inhaled corticosteroids are rarely if ever used on their own to treat COPD.
Whilepulmonary function testsmay be ordered to evaluate lung function, it is the frequency of exacerbations (a.k.a. “attacks”) that will ultimately determine if Symbicort is appropriate.
How COPD Is Treated
Precautions and Considerations
Symbicort should never be used in anyone with a known or suspected allergy to budesonide or formoterol.
Because cross-allergy between corticosteroids is common, Symbicort should be prescribed with caution if you’ve ever had an allergic reaction to other inhaled steroids like:
People with certain pre-existing health conditions also should use caution when taking Symbicort, as long-term use of corticosteroids can affect eyes, reduce bone mineral, and impair the function of the adrenal gland.The benefits and risks of treatment should be weighed for people with:
Symbicort is not contraindicated for use with these conditions, but it can make them worse. See your healthcare provider regularly to monitor for progression of these pre-existing diseases if you use Symbicort.
Any child who has not been vaccinated for or previously exposed tomeaslesorchickenpoxshould be vaccinated prior to the start of treatment. Because of itsimmunosuppressiveeffects, Symbicort can make these childhood infections worse and, in some cases, fatal. If a non-immunized child is exposed to measles or chickenpox while on Symbicort, let your healthcare provider know.
Symbicort may also not be appropriate if you have a severe pre-existing infection that has not been resolved, includingtuberculosis,shingles, and other serious bacterial, fungal, viral, or parasitic infections. Because of Symbicort’s immunosuppressive effect, its use may need to be delayed until the infection is fully treated.
Animal studies suggest a potential risk of fetal harm when using Symbicort but no well-controlled human studies are available. The benefits of treatment may outweigh the risks in some cases.
If you a pregnant, planning to become pregnant, or breastfeeding, speak with your healthcare provider before using Symbicort to fully understand the benefits and risks of treatment for you.
Symbicort is available as ametered-dose inhaler (MDI), a type of inhaler that uses an aerosolized propellent to deliver the medication deep into your lungs.
It comes in two different strengths:
Symbicort can provide relief within 15 minutes, but the full benefits of the drug may not be felt until after two weeks or more of uninterrupted use.
Call your healthcare provider if you have no improvement in your condition after one week of use, have worsening symptoms, need to use a rescue inhaler two or more days in a row, or yourpeak flow meterresults worsen.
Symbicort is not intended for permanent use in all people. Once symptom control is achieved, treatment may be stepped down to a low- or medium-dose inhaled corticosteroid, if appropriate.
Other Inhalers Used for COPD
How to Take and Store
People who have had asthma for some time are generally familiar with MDIs like Symbicort. The devices are relatively easy to use but do require hand/breath coordination to ensure the right amount of medication gets into the lungs.
Symbicort MDI inhaler is used as follows:
With every compression of the inhaler, the built-in counter will tell you how many doses are left. Be sure to refill your prescription when the counter approaches 20.
Symbicort MDI inhalers can be stored at room temperature, ideally between 68 and 77 degrees F. Store the inhaler with the mouthpiece down. Do not puncture the canister or place it near a heat source as this can cause bursting.
Never use an inhaler past its expiration date. Keep it out of the reach of children and pets.
How to Make Meter Dose Inhalers Work Better
As with any drug, Symbicort may cause side effects. If they occur, they tend to be mild and will generally improve as your body adapts to treatment. If symptoms persist or worsen, let your healthcare provider know.
Common
The side effects for both Symbicort formulations are similar, although people tend to have more gastrointestinal side effects with the higher-dose formulation. It is for this reason that the lowest possible dose should be used whenever possible.
Thefrequencyof symptoms, however, varies between Symbicort 80/4.5-mcg inhaler and Symbicort 160/4.5-mcg inhaler.
Among the side effects affecting at least 1% of Symbicort users, in order of frequency of occurrence:
Symbicort 80/4.5 mcgCommon cold (10.5%)Upper respiratory infection (7.6%)Headache (6.5%)Sore throat (6.1%)Sinus infection (5.8%)Influenza (3.2%)Back pain (3.2%)Stuffy nose (2.5%)Vomiting (1.4%)Oral thrush (1.4%)Stomach ache (1.1%)Symbicort 160/4.5 mcgHeadache (11.3%)Upper respiratory infection (10.5%)Common cold (9.7%)Sore throat (8.9%)Stomach ache (6.5%)Sinus infection (4.8%)Vomiting (3.2%)Oral thrush (3.2%)Stuffy nose (3.2%)Influenza (2.4%)Back pain (1.6%)
Symbicort 80/4.5 mcgCommon cold (10.5%)Upper respiratory infection (7.6%)Headache (6.5%)Sore throat (6.1%)Sinus infection (5.8%)Influenza (3.2%)Back pain (3.2%)Stuffy nose (2.5%)Vomiting (1.4%)Oral thrush (1.4%)Stomach ache (1.1%)
Common cold (10.5%)
Upper respiratory infection (7.6%)
Headache (6.5%)
Sore throat (6.1%)
Sinus infection (5.8%)
Influenza (3.2%)
Back pain (3.2%)
Stuffy nose (2.5%)
Vomiting (1.4%)
Oral thrush (1.4%)
Stomach ache (1.1%)
Symbicort 160/4.5 mcgHeadache (11.3%)Upper respiratory infection (10.5%)Common cold (9.7%)Sore throat (8.9%)Stomach ache (6.5%)Sinus infection (4.8%)Vomiting (3.2%)Oral thrush (3.2%)Stuffy nose (3.2%)Influenza (2.4%)Back pain (1.6%)
Headache (11.3%)
Upper respiratory infection (10.5%)
Common cold (9.7%)
Sore throat (8.9%)
Stomach ache (6.5%)
Sinus infection (4.8%)
Vomiting (3.2%)
Oral thrush (3.2%)
Stuffy nose (3.2%)
Influenza (2.4%)
Back pain (1.6%)
One of the most common symptoms of inhaled corticosteroid use isoral candidiasis (thrush). Rinsing your mouth thoroughly after each treatment and using a spacer can go a long way toward avoiding this common fungal infection.
How to Reduce Inhaled Corticosteroid Side Effects
Severe
The risk of pneumonia in patients with COPD or asthma taking inhaled corticosteroids is unclear with some studies reporting no risk or a small increase in risk.
Equally rare is a potentially life-threatening allergy known asanaphylaxisin which exposure to budesonide or formoterol can trigger a severe whole-body reaction. If left untreated, anaphylaxis can lead to shock, coma, cardiac or respiratory failure, and death.
On rare occasions, Symbicort can cause a reaction known as paradoxical bronchospasm in which respiratory symptoms worsen rather than improve after use. Although this is more common withrescue inhalersthan with LABA-containing inhalers, it can still occur.
COPD and Bacterial Pneumonia Risk
Combination corticosteroid/LABA inhalers have long carried aboxed warningadvising consumers that this class of drug may increase the risk of asthma-related death. The warning was based on a single, 28-week trial in 2006 in which a related LABA called salmeterol caused 13 deaths among 13,179 users.
Subsequent research has shown that while single-ingredient LABAs may be harmful, combination inhalers like Symbicort pose no such risk because the LABA dose is so low. In 2017, the FDA approved the removal of the boxed warning on all combination steroid/LABA inhalers.
Taking higher doses of Symbicort will not improve your asthma or COPD symptoms. Doing so may lead to tremors, shakiness, chest pain, fast or irregular heartbeat, nausea, vomiting, and seizures. Severe overdoses may require hospitalization with cardiac monitoring.
Do not take a beta-blocker if you experience signs of overdose. The treatment needs to be medically supervised, and some beta-blockers can trigger an asthma attack if used inappropriately.
Concerning Combinations
Symbicort can interact with certain drugs that use the same liver enzyme, cytochrome P450 (CYP450), for metabolization. The competition for CYP450 can cause adverse changes in the blood concentration of one or both drugs.
Among the drugs of greatest concern are those that strongly inhibit CYP450, including:
Other drugs can cause adverse effects and should be used with extreme caution, including:
To avoid interactions, tell your healthcare provider about all drugs you take, including prescription, over-the-counter, herbal, or recreational drugs.
What to Do When COPD and Asthma Overlap
17 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.U.S. Food and Drug Administration.Approved drug products with therapeutic equivalence evaluations.Food and Drug Administration.FDA approves first generic of Symbicort to treat asthma and COPD.AstraZeneca.Symbicort (budesonide and formoterol fumarate dihydrate) Inhalation Aerosol, for oral inhalation use.Rogliani P, Ora J, Puxeddu E, Cazzola M.Airflow obstruction: is it asthma or is it COPD?.Int J Chron Obstruct Pulmon Dis. 2016;11:3007-13. doi:10.2147/COPD.S54927Tashkin DP, Strange C.Inhaled corticosteroids for chronic obstructive pulmonary disease: what is their role in therapy?.Int J Chron Obstruct Pulmon Dis.2018;13:2587-601. doi:10.2147/COPD.S172240Wark P.Bronchitis (acute).BMJ Clin Evid. 2015;2015:1508.American Lung Association.Assess and monitor your asthma control.Morales DR.LABA monotherapy in asthma: an avoidable problem.Br J Gen Pract.2013;63(617):627-8. doi:10.3399/bjgp13X675250Tang W, Sun L, Fizgerald JM.A paradigm shift in the treatment of mild asthma?.JThorac Dis.2018;10(10):5655-8. doi:10.21037/jtd.2018.09.127Roth OZ, Ostroff JL.A review of the 2019 GOLD guidelines for COPD.US Pharm. 2019;44(7):HS8-HS16.Knarborg M, Bendstrup E, Hilberg O.Increasing awareness of corticosteroid hypersensitivity reactions is important.Respirol Case Rep. 2013;1(2):43-5. doi:10.1002/rcr2.13Yasir M, Goyal A, Bansal P, Sonthalia S.Corticosteroid adverse effects. In: StatPearls.Umaretiya PJ, Swanson JB, Kwon HJ, Grose C, Lohse CM, Juhn YJ.Asthma and risk of breakthrough varicella infection in children.Allergy Asthma Proc.2016;37(3):207-15. doi:10.2500/aap.2016.37.3951Qian C, Coulombe J, Suissa S, Ernst P.Pneumonia risk in asthma patients using inhaled corticosteroids: a quasi-cohort study.Br J Clin Pharmol.2017;83:2077-86. doi:10.1111/bcp.13295Kalayci O, Abdelateef H, Pozo Beltrán CF, et al.Challenges and choices in the pharmacological treatment of non-severe pediatric asthma: A commentary for the practicing physician.World Allergy Organ J. 2019;12(9):100054. doi:10.1016/j.waojou.2019.100054Hasford J, Virchow JC.Excess mortality in patients with asthma on long-acting beta2-agonists.Eur Respir J.2006;28(5):900-2. doi:10.1183/09031936.00085606U.S. Food and Drug Administration.FDA drug safety communication: FDA review finds no significant increase in risk of serious asthma outcomes with long-acting beta agonists (LABAs) used in combination with inhaled corticosteroids (ICS).
17 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.U.S. Food and Drug Administration.Approved drug products with therapeutic equivalence evaluations.Food and Drug Administration.FDA approves first generic of Symbicort to treat asthma and COPD.AstraZeneca.Symbicort (budesonide and formoterol fumarate dihydrate) Inhalation Aerosol, for oral inhalation use.Rogliani P, Ora J, Puxeddu E, Cazzola M.Airflow obstruction: is it asthma or is it COPD?.Int J Chron Obstruct Pulmon Dis. 2016;11:3007-13. doi:10.2147/COPD.S54927Tashkin DP, Strange C.Inhaled corticosteroids for chronic obstructive pulmonary disease: what is their role in therapy?.Int J Chron Obstruct Pulmon Dis.2018;13:2587-601. doi:10.2147/COPD.S172240Wark P.Bronchitis (acute).BMJ Clin Evid. 2015;2015:1508.American Lung Association.Assess and monitor your asthma control.Morales DR.LABA monotherapy in asthma: an avoidable problem.Br J Gen Pract.2013;63(617):627-8. doi:10.3399/bjgp13X675250Tang W, Sun L, Fizgerald JM.A paradigm shift in the treatment of mild asthma?.JThorac Dis.2018;10(10):5655-8. doi:10.21037/jtd.2018.09.127Roth OZ, Ostroff JL.A review of the 2019 GOLD guidelines for COPD.US Pharm. 2019;44(7):HS8-HS16.Knarborg M, Bendstrup E, Hilberg O.Increasing awareness of corticosteroid hypersensitivity reactions is important.Respirol Case Rep. 2013;1(2):43-5. doi:10.1002/rcr2.13Yasir M, Goyal A, Bansal P, Sonthalia S.Corticosteroid adverse effects. In: StatPearls.Umaretiya PJ, Swanson JB, Kwon HJ, Grose C, Lohse CM, Juhn YJ.Asthma and risk of breakthrough varicella infection in children.Allergy Asthma Proc.2016;37(3):207-15. doi:10.2500/aap.2016.37.3951Qian C, Coulombe J, Suissa S, Ernst P.Pneumonia risk in asthma patients using inhaled corticosteroids: a quasi-cohort study.Br J Clin Pharmol.2017;83:2077-86. doi:10.1111/bcp.13295Kalayci O, Abdelateef H, Pozo Beltrán CF, et al.Challenges and choices in the pharmacological treatment of non-severe pediatric asthma: A commentary for the practicing physician.World Allergy Organ J. 2019;12(9):100054. doi:10.1016/j.waojou.2019.100054Hasford J, Virchow JC.Excess mortality in patients with asthma on long-acting beta2-agonists.Eur Respir J.2006;28(5):900-2. doi:10.1183/09031936.00085606U.S. Food and Drug Administration.FDA drug safety communication: FDA review finds no significant increase in risk of serious asthma outcomes with long-acting beta agonists (LABAs) used in combination with inhaled corticosteroids (ICS).
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
U.S. Food and Drug Administration.Approved drug products with therapeutic equivalence evaluations.Food and Drug Administration.FDA approves first generic of Symbicort to treat asthma and COPD.AstraZeneca.Symbicort (budesonide and formoterol fumarate dihydrate) Inhalation Aerosol, for oral inhalation use.Rogliani P, Ora J, Puxeddu E, Cazzola M.Airflow obstruction: is it asthma or is it COPD?.Int J Chron Obstruct Pulmon Dis. 2016;11:3007-13. doi:10.2147/COPD.S54927Tashkin DP, Strange C.Inhaled corticosteroids for chronic obstructive pulmonary disease: what is their role in therapy?.Int J Chron Obstruct Pulmon Dis.2018;13:2587-601. doi:10.2147/COPD.S172240Wark P.Bronchitis (acute).BMJ Clin Evid. 2015;2015:1508.American Lung Association.Assess and monitor your asthma control.Morales DR.LABA monotherapy in asthma: an avoidable problem.Br J Gen Pract.2013;63(617):627-8. doi:10.3399/bjgp13X675250Tang W, Sun L, Fizgerald JM.A paradigm shift in the treatment of mild asthma?.JThorac Dis.2018;10(10):5655-8. doi:10.21037/jtd.2018.09.127Roth OZ, Ostroff JL.A review of the 2019 GOLD guidelines for COPD.US Pharm. 2019;44(7):HS8-HS16.Knarborg M, Bendstrup E, Hilberg O.Increasing awareness of corticosteroid hypersensitivity reactions is important.Respirol Case Rep. 2013;1(2):43-5. doi:10.1002/rcr2.13Yasir M, Goyal A, Bansal P, Sonthalia S.Corticosteroid adverse effects. In: StatPearls.Umaretiya PJ, Swanson JB, Kwon HJ, Grose C, Lohse CM, Juhn YJ.Asthma and risk of breakthrough varicella infection in children.Allergy Asthma Proc.2016;37(3):207-15. doi:10.2500/aap.2016.37.3951Qian C, Coulombe J, Suissa S, Ernst P.Pneumonia risk in asthma patients using inhaled corticosteroids: a quasi-cohort study.Br J Clin Pharmol.2017;83:2077-86. doi:10.1111/bcp.13295Kalayci O, Abdelateef H, Pozo Beltrán CF, et al.Challenges and choices in the pharmacological treatment of non-severe pediatric asthma: A commentary for the practicing physician.World Allergy Organ J. 2019;12(9):100054. doi:10.1016/j.waojou.2019.100054Hasford J, Virchow JC.Excess mortality in patients with asthma on long-acting beta2-agonists.Eur Respir J.2006;28(5):900-2. doi:10.1183/09031936.00085606U.S. Food and Drug Administration.FDA drug safety communication: FDA review finds no significant increase in risk of serious asthma outcomes with long-acting beta agonists (LABAs) used in combination with inhaled corticosteroids (ICS).
U.S. Food and Drug Administration.Approved drug products with therapeutic equivalence evaluations.
Food and Drug Administration.FDA approves first generic of Symbicort to treat asthma and COPD.
AstraZeneca.Symbicort (budesonide and formoterol fumarate dihydrate) Inhalation Aerosol, for oral inhalation use.
Rogliani P, Ora J, Puxeddu E, Cazzola M.Airflow obstruction: is it asthma or is it COPD?.Int J Chron Obstruct Pulmon Dis. 2016;11:3007-13. doi:10.2147/COPD.S54927
Tashkin DP, Strange C.Inhaled corticosteroids for chronic obstructive pulmonary disease: what is their role in therapy?.Int J Chron Obstruct Pulmon Dis.2018;13:2587-601. doi:10.2147/COPD.S172240
Wark P.Bronchitis (acute).BMJ Clin Evid. 2015;2015:1508.
American Lung Association.Assess and monitor your asthma control.
Morales DR.LABA monotherapy in asthma: an avoidable problem.Br J Gen Pract.2013;63(617):627-8. doi:10.3399/bjgp13X675250
Tang W, Sun L, Fizgerald JM.A paradigm shift in the treatment of mild asthma?.JThorac Dis.2018;10(10):5655-8. doi:10.21037/jtd.2018.09.127
Roth OZ, Ostroff JL.A review of the 2019 GOLD guidelines for COPD.US Pharm. 2019;44(7):HS8-HS16.
Knarborg M, Bendstrup E, Hilberg O.Increasing awareness of corticosteroid hypersensitivity reactions is important.Respirol Case Rep. 2013;1(2):43-5. doi:10.1002/rcr2.13
Yasir M, Goyal A, Bansal P, Sonthalia S.Corticosteroid adverse effects. In: StatPearls.
Umaretiya PJ, Swanson JB, Kwon HJ, Grose C, Lohse CM, Juhn YJ.Asthma and risk of breakthrough varicella infection in children.Allergy Asthma Proc.2016;37(3):207-15. doi:10.2500/aap.2016.37.3951
Qian C, Coulombe J, Suissa S, Ernst P.Pneumonia risk in asthma patients using inhaled corticosteroids: a quasi-cohort study.Br J Clin Pharmol.2017;83:2077-86. doi:10.1111/bcp.13295
Kalayci O, Abdelateef H, Pozo Beltrán CF, et al.Challenges and choices in the pharmacological treatment of non-severe pediatric asthma: A commentary for the practicing physician.World Allergy Organ J. 2019;12(9):100054. doi:10.1016/j.waojou.2019.100054
Hasford J, Virchow JC.Excess mortality in patients with asthma on long-acting beta2-agonists.Eur Respir J.2006;28(5):900-2. doi:10.1183/09031936.00085606
U.S. Food and Drug Administration.FDA drug safety communication: FDA review finds no significant increase in risk of serious asthma outcomes with long-acting beta agonists (LABAs) used in combination with inhaled corticosteroids (ICS).
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