Symbicort is a twice-daily inhaler that delivers two medications in each puff: one that reduces airway inflammation and another that relaxes the muscles around your airways. Using it correctly matters more than you might think. Poor technique can mean a significant portion of the medication never reaches your lungs. Here’s exactly how to use it, from priming a new inhaler to maintaining it over time.
Priming a New Inhaler
Before you use a brand-new Symbicort inhaler for the first time, you need to prime it. This clears the valve and ensures your first real dose delivers the right amount of medication. Hold the inhaler upright, shake it well for 5 seconds, point it away from your face, and press down firmly on the top of the canister to release a spray into the air. Shake it again for another 5 seconds and release a second spray. That’s it: two test sprays and the inhaler is ready.
You also need to re-prime if you haven’t used the inhaler for more than 7 days or if you drop it. The same two-shake, two-spray process applies each time.
Step-by-Step Inhalation
Each dose of Symbicort is two puffs, taken twice a day (morning and evening). Here’s how to take each puff:
- Shake the inhaler well for 5 seconds before every puff, not just the first one.
- Breathe out fully, away from the inhaler, so your lungs are as empty as comfortable.
- Seal your lips around the mouthpiece and press down on the canister while breathing in slowly and deeply through your mouth.
- Hold your breath for about 10 seconds, or as long as you comfortably can. This gives the medication time to settle into your airways.
- Breathe out gently, away from the mouthpiece.
- Wait about 30 seconds, then shake the inhaler again and repeat for your second puff.
A slow, steady inhale is key with the pressurized aerosol version of Symbicort. If you breathe in too fast, much of the medication hits the back of your throat instead of traveling deep into your lungs. Time the press of the canister with the start of your breath in so the spray and your inhale are synchronized.
If You Use the Turbuhaler Version
Some countries dispense Symbicort as a Turbuhaler, which is a dry powder inhaler rather than a pressurized spray. The technique is different: instead of pressing a canister, you twist the base to load a dose, then breathe in deeply and forcefully. There’s no propellant pushing the medication out, so your breath does all the work. The Turbuhaler version has a dose counter that counts down from 120, with the last 20 doses appearing in red as a reminder to refill.
Rinse Your Mouth After Every Use
This step is easy to skip and important not to. The steroid component in Symbicort can cause oral thrush, a yeast infection that produces white patches, soreness, and an unpleasant taste in your mouth. After each session (both puffs), rinse your mouth thoroughly with water, gargle, and spit it out. Don’t swallow the rinse water.
Some people find that brushing their teeth after using the inhaler provides extra protection. If you’ve dealt with recurring thrush despite rinsing, brushing your teeth and using a small amount of mouthwash can help clear residual medication from your mouth and tongue.
Dosage and Strengths
Symbicort comes in two strengths: 80/4.5 and 160/4.5. The first number is the dose of the anti-inflammatory steroid in micrograms per puff, and the second is the dose of the airway-opening bronchodilator. Your prescribed strength depends on how severe your asthma or COPD is.
The standard dose for adults and adolescents 12 and older is two puffs twice daily. The maximum recommended daily dose is two puffs of the higher strength (160/4.5) twice daily, which adds up to eight total puffs. Going beyond that increases the bronchodilator to levels that aren’t considered safe. Symbicort is not currently established as effective for children under 12 in the U.S.
Using Symbicort as Maintenance and Rescue
Your prescriber may put you on what’s called SMART therapy, where Symbicort serves as both your daily maintenance inhaler and your rescue inhaler for sudden symptoms. This approach uses the 160/4.5 strength. You take your regular one or two puffs once or twice daily as a baseline, then take an additional puff whenever you need relief from breakthrough symptoms.
The ceiling for SMART therapy is 12 total inhalations in a single day. If you’re regularly hitting that number, your asthma isn’t well controlled and your treatment plan likely needs adjustment. Not everyone on Symbicort uses it this way, so follow whatever regimen your prescriber set up for you.
Tracking Your Doses
The pressurized Symbicort inhaler has a built-in dose counter on the canister. Watch for the counter entering a red zone, which signals that roughly 20 doses remain. This is your cue to get a refill so you don’t run out. When the counter reads zero, the inhaler is empty and should be replaced, even if it feels like something still sprays out. The remaining propellant can give the illusion of a dose when there’s little to no medication left.
Cleaning and Storage
Medication residue builds up around the mouthpiece over time and can partially block the spray. Clean your inhaler at least once a week. For the pressurized aerosol version, pull the metal canister out of the plastic casing, remove the mouthpiece cap, and rinse the plastic casing under warm running water for about 30 seconds. Let it dry completely before putting the canister back in. Never let the metal canister itself get wet. Once reassembled, release one test puff into the air to confirm it’s working.
For the Turbuhaler version, never use water. Moisture will clump the dry powder and prevent it from dispensing properly. Instead, wipe the inside and outside of the mouthpiece with a clean, dry cloth.
Store Symbicort at room temperature, away from direct heat and humidity. Don’t leave it in a hot car or a steamy bathroom, as extreme temperatures can affect the canister pressure and medication stability.
Signs Something Isn’t Right
In rare cases, Symbicort can trigger paradoxical bronchospasm, meaning your airways tighten immediately after using the inhaler instead of opening up. If you suddenly feel more short of breath right after a puff, use your short-acting rescue inhaler and stop using the Symbicort. This requires a call to your prescriber to switch to a different medication.
Beyond that, pay attention to how often you’re reaching for a separate rescue inhaler. If you need it more frequently than usual, or if it doesn’t seem to relieve symptoms the way it used to, your underlying condition is likely worsening. The same applies if your symptoms haven’t improved after using Symbicort regularly for a full week. These are all signals that your treatment plan needs a reassessment, not just more puffs.