Symbicort is a combination inhaler used to treat asthma and chronic obstructive pulmonary disease (COPD). It contains two active ingredients that work together: one reduces inflammation in the airways, and the other relaxes the muscles around them to improve airflow. It’s FDA-approved for asthma in patients 6 years and older, and for maintenance treatment of COPD, including chronic bronchitis and emphysema.
How the Two Ingredients Work Together
Symbicort combines budesonide, an inhaled corticosteroid, with formoterol, a long-acting bronchodilator. Each targets a different part of the problem. Budesonide reduces the swelling and inflammation inside your airways that makes them narrow and reactive. It works against the immune cells and chemical signals that drive allergic and non-allergic inflammation in the lungs. This effect builds over days to weeks of consistent use.
Formoterol works much faster. It relaxes the smooth muscle that wraps around your airways, opening them within 1 to 3 minutes of inhalation. That relief lasts at least 12 hours per dose. By pairing an anti-inflammatory with a bronchodilator in one inhaler, Symbicort addresses both the underlying cause of airway narrowing and the immediate sensation of tightness or breathlessness.
Asthma Treatment
For asthma, Symbicort is a daily maintenance inhaler, not a one-time rescue medication. The standard regimen is 2 inhalations twice a day, morning and evening, roughly 12 hours apart. It comes in two strengths: 80/4.5 and 160/4.5, referring to the micrograms of budesonide and formoterol in each puff. Children ages 6 to 11 typically use the lower strength, while adolescents and adults may use either.
Beyond daily maintenance, international asthma guidelines now recommend Symbicort for a strategy called SMART (single maintenance and reliever therapy). Under this approach, you use the same Symbicort inhaler for both your scheduled daily doses and as needed when symptoms flare. The Global Initiative for Asthma and the U.S. National Asthma Education and Prevention Program both recommend SMART at moderate and higher steps of asthma management. The formoterol component’s rapid onset is what makes this possible: it provides quick relief like a rescue inhaler while also delivering an extra dose of the anti-inflammatory with each use.
With SMART, the daily maintenance dose can be as low as one inhalation once or twice daily for moderate asthma, with additional puffs taken as needed for symptom relief. Adults and adolescents can take up to 12 total inhalations in a single day if symptoms demand it. For children ages 4 to 11, SMART is typically prescribed as one puff of the lower-strength formulation once daily, with one additional puff as needed.
COPD Treatment
For COPD, Symbicort is approved at the higher strength (160/4.5), taken as 2 inhalations twice daily. Its goals in COPD are slightly different than in asthma: it helps maintain open airways day to day and reduces the frequency of exacerbations, those sudden worsening episodes that can land people in the hospital.
A six-month clinical trial called the RISE study found that Symbicort reduced the annual rate of COPD exacerbations by 24% compared to formoterol alone. Patients on the combination inhaler also took significantly longer before experiencing their first flare-up. Importantly, the addition of the corticosteroid component did not increase pneumonia risk in that study, which has been a concern with some inhaled steroids in COPD patients.
What to Expect When Using It
Because formoterol acts within minutes, you’ll likely notice some breathing relief almost immediately after your first puff. The full anti-inflammatory benefit of budesonide, however, takes longer to develop. It may be days or even a couple of weeks before you feel the complete effect on airway swelling and sensitivity. This is why consistent, twice-daily use matters even when you feel fine.
After each use, rinsing your mouth with water and spitting it out helps prevent oral thrush, a yeast infection that can develop when corticosteroid residue sits on the tissues of your mouth and throat. This is a common precaution with all inhaled corticosteroids, not unique to Symbicort.
The most commonly reported side effects in clinical trials were mild: throat irritation, headache, and upper respiratory infections like the common cold. Nasopharyngitis (a stuffy or runny nose) appeared in about 5% of patients in COPD studies.
Available Strengths and Generic Options
Symbicort is available as a metered-dose inhaler in two strengths. The 80/4.5 version delivers 80 micrograms of budesonide and 4.5 micrograms of formoterol per puff. The 160/4.5 version doubles the corticosteroid dose while keeping the same amount of formoterol. Your prescribed strength depends on the severity of your condition and your age.
A generic version called Breyna, made by Mylan, received FDA approval in March 2022 and became available for purchase in mid-2023. It comes in both strengths and is rated as therapeutically equivalent to brand-name Symbicort, which means it can typically be substituted at the pharmacy. The availability of a generic option has made this combination more accessible for patients dealing with high inhaler costs.
What Symbicort Does Not Do
Symbicort is not designed to stop an asthma attack already in progress, unless your provider has specifically prescribed it under the SMART approach described above. If you’re using Symbicort only as a maintenance inhaler, you still need a separate short-acting rescue inhaler for sudden symptoms. Symbicort also does not replace oral corticosteroids for severe flare-ups that need more aggressive treatment.
It is not approved for children under 6 with asthma, and the COPD indication applies only to adults. People with a known hypersensitivity to either budesonide or formoterol should not use it. Because formoterol can affect heart rate, people with certain cardiovascular conditions or those taking medications that interact with bronchodilators may need close monitoring or an alternative treatment plan.