How It Works
The budesonide / formoterol inhaler works by:
- Reducing inflammation: Budesonide is a corticosteroid. It works by traveling deep into the lungs to lower swelling and irritation in the airway walls. This calms the lungs and reduces their reaction to triggers, such as pollen, dust, or cold air.
- Relaxing airway muscles: Formoterol is a long-acting bronchodilator. While the steroid treats the swelling, formoterol targets the muscles wrapped around the airways. It helps these muscles relax so airway passages remain open for air to flow more freely.
By addressing swelling and tightening, this inhaler treats respiratory issues. Full benefits are usually seen after two weeks of consistent use.
| Quick Facts | |
|---|---|
| Common Brands | Symbicort, Breyna |
| Drug Class | Inhaled corticosteroid (ICS) / long-acting beta-agonist (LABA) |
| Generic Status | Generic version available |
| Availability | Prescription only |
Dosing
Budesonide / formoterol is typically supplied as a metered-dose inhaler (MDI) in two strengths: 80/4.5 mcg and 160/4.5 mcg.
Below are the standard dosing guidelines for the prescription inhaler:
- Typical dose: Most providers recommend two puffs in the morning and two puffs in the evening.
- Timing: It’s generally recommended that doses be spaced approximately 12 hours apart.
- Consistency: Standard guidelines suggest using the inhaler every day, even if symptoms are not present. Stopping the medication can cause inflammation to return.
- Priming: If the inhaler is new or has not been used for more than seven days, it’s generally recommended that it be primed by shaking it and releasing two test sprays into the air away from your face.
Note: Dosing information below is educational only. Your prescribing physician will determine your specific dose based on your individual health needs. Always follow your healthcare provider’s instructions for exact dosing.
Uses
FDA-Approved Uses
Budesonide / formoterol inhaler is FDA-approved for:
- Asthma maintenance: Long-term treatment for the respiratory condition
- COPD maintenance: Reducing flare-ups and improving breathing in people with chronic bronchitis or emphysema
Off-Label Uses
You may see budesonide / formoterol prescribed for uses that are not FDA-approved. This is a common and legal practice called off-label prescribing, where a doctor uses their clinical judgment to prescribe a drug for a different (but well-researched) purpose.
Budesonide / formoterol inhaler may be prescribed for the following conditions:
- SMART therapy: Some doctors use this specific inhaler for Single Maintenance and Reliever Therapy (SMART), where the patient uses the same inhaler for daily prevention and as-needed rescue relief.
- Post-infectious cough: Occasionally used to settle high levels of airway inflammation following a viral infection.
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Side Effects
Most people tolerate inhaled medications well because the drug stays mostly in the lungs rather than circulating throughout the body. However, side effects can still occur.
Common Side Effects
- Sore throat or mouth pain
- Hoarseness or voice changes
- Headache
- Common cold symptoms (nasal congestion, sneezing)
- Back pain
- Stomach discomfort or nausea
Serious Side Effects
Serious side effects are rare, but it’s important to know what to look for if they do occur.
It’s generally accepted that you stop taking the medication and immediately call the doctor if you experience any of the following symptoms:
- Oral thrush: A fungal infection in the mouth, appearing as white patches or redness
- Paradoxical bronchospasm: A rare reaction where breathing gets suddenly worse immediately after using the inhaler
- Heart and blood pressure problems: Fast or irregular heartbeat, chest pain, or a significant increase in blood pressure
- Pneumonia: Increased risk in patients with COPD, marked by fever, increased mucus, and worsening cough
- Bone and eye health: Long-term use of high-dose steroids can lead to bone thinning (osteoporosis), glaucoma, or cataracts
Call your doctor immediately if you experience any concerning or prolonged symptoms.
Pharmacist Tips
Rinse and Spit
After your morning and evening doses, it’s generally advised to rinse your mouth with water and spit it out. This helps remove leftover steroid powder from your tongue and throat, which lowers your risk of developing oral thrush.
Check the Counter
MDIs have a built-in dose counter. It is generally recommended to request a refill when the counter reaches 20. Providers advise throwing the inhaler away when it reaches 0, even if you still hear medication inside. The remaining medication may not contain enough medicine to be effective.
Shake Before Each Dose
To ensure the two medications are mixed properly, standard guidelines recommend shaking the inhaler for at least five seconds before each dose.
The 10-Second Hold
After inhaling the medicine, providers advise holding your breath for 10 seconds. This gives the heavy particles time to settle deep into the small airways where they are needed most.
Wipe, Don’t Wash
It’s generally recommended to clean the mouthpiece once a week with a dry tissue. Standard guidelines advise against putting the metal canister in water, as this can ruin the medicine.
Keep a Rescue Inhaler
Unless your doctor has put you on a SMART plan, it’s generally recommended to keep a separate rescue inhaler (like albuterol) with you for severe breathing emergencies.
Drug Interactions
The budesonide / formoterol inhaler can interact with other medications. Let your doctor know if you take any of the following medications:
- Beta-blockers: Common blood pressure medications like metoprolol or atenolol can block the effects of the formoterol, causing your airways to tighten.
- Antifungals: Medications like ketoconazole can increase the amount of budesonide that gets into your bloodstream, raising the risk of steroid-related side effects.
- Monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants: These can increase the impact of formoterol on your heart rate and blood pressure.
- Diuretics: Some water pills can lower your potassium levels. Using them with this inhaler may cause potassium levels to drop further, potentially affecting your heart rhythm.
Always give your doctor and pharmacist a complete list of all your medications, vitamins, and supplements to check for potential interactions.
FAQs
Why must I rinse my mouth after every use?
The budesonide in the inhaler is a steroid. If the powder stays on your tongue or the back of your throat, it can suppress the local immune system in your mouth, allowing yeast to overgrow. Rinsing and spitting prevents this infection, known as oral thrush.
Is this a daily controller medication or a rescue inhaler?
In standard therapy, it is a daily controller. It’s generally advised that you use it daily to help keep inflammation down. It does not replace a rescue inhaler for sudden, severe attacks unless your doctor has instructed you otherwise.
Does this inhaler contain steroids?
Yes, budesonide is a corticosteroid. Inhaled steroids are designed to mimic the natural anti-inflammatory hormones in your body and target the lungs.
Why does my heart race after taking a puff?
The formoterol component is a stimulant for the airway muscles. In some people, it can briefly stimulate the heart, causing a racing sensation or minor tremors. This usually fades within a few minutes.
Do I need to shake the inhaler before using it?
Yes. Shaking ensures that budesonide and formoterol are properly mixed with the propellant so you get the correct dose of both medications with every dose.
Can I use a spacer or chamber device with this inhaler?
Yes. Providers typically recommend using a spacer with MDI inhalers to help the medicine get past the back of your throat and into your lungs. Using a spacer can reduce the risk of side effects like hoarseness.
Can I stop using it once my breathing feels normal again?
No. Breathing feels normal because the medication is working. If you stop, the underlying inflammation will return, which could lead to a severe flare-up or asthma attack.
How do I read the dose counter, and how do I know when it is truly empty?
The counter on the back shows the remaining doses. When it gets to the red zone (usually around 20 doses remaining), it is time for a refill. When it reaches 0, the device is empty and should be discarded.
Is it safe to use this inhaler during pregnancy?
Budesonide is a common treatment for maintaining asthma control during pregnancy, but it’s generally advised that you discuss your specific situation with your doctor.
How do I clean the mouthpiece without ruining the medicine inside?
Standard guidelines recommend using a dry cloth or a cotton swab to wipe the inside and outside of the mouthpiece once a week. Providers do not advise submerging the device in water.
Does this medication cure asthma/COPD or just manage the symptoms?
There is currently no cure for asthma or COPD. Budesonide / formoterol is a maintenance therapy used to manage the symptoms and prevent them from occurring. It controls the underlying inflammation and muscle tightening.
Can this medication interact with beta-blockers?
Yes. Beta-blockers (often used for heart health) can interfere with the long-acting bronchodilator in the inhaler, making it less effective and potentially causing your airways to constrict.
Does this inhaler make me more susceptible to pneumonia?
There is a slightly increased risk of pneumonia reported in patients with COPD who use inhaled steroids. If you notice a fever or a change in the color of your mucus, it’s generally advised that you contact your provider.
Comparable Medications
Symbicort, Breyna, Advair, Breo, Airsupra, or Flovent?
Here are some possible alternatives to budesonide / formoterol inhaler:
Symbicort / Breyna
These are identical in terms of active ingredients (budesonide / formoterol). Symbicort is a brand-name medicine, while Breyna is a newer generic version of Symbicort. They provide anti-inflammatory and 12-hour bronchodilator effects.
Advair
A similar combination inhaler. The main difference is the specific steroid and LABA used. Advair’s salmeterol may take longer to start working than Symbicort's formoterol.
Breo Ellipta
From $589.99
A combination inhaler that is used once a day because its components stay in the system for 24 hours, whereas budesonide / formoterol is a twice-daily medication.
Albuterol HFA
From $39.99
A rescue inhaler only. It contains no steroids and lasts about 4 hours. It is used for quick relief, not daily control.
Airsupra Inhaler
From $674.99
A newer type of rescue inhaler that provides quick relief and a dose of steroid at the same time. It is used as needed, unlike the daily schedule of budesonide / formoterol.
Flovent
A steroid-only inhaler. It reduces inflammation but does not have the long-acting muscle relaxant component found in budesonide / formoterol combinations.
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Important: Information on this page is for educational purposes only. Prescribing decisions are made by independent, licensed providers. TelyRx operates technology-enabled pharmacies and a telehealth platform that connects patients with board-certified licensed providers. Prescriptions, when provider-approved and issued, are filled and shipped by TelyRx-affiliated pharmacies. We do not employ physicians or make prescribing decisions. Learn more about our editorial standards here.