Inhaler Selection Guide
Find Your Best Match
Answer these questions to get personalized recommendations for asthma or COPD inhalers.
When your doctor prescribes an inhaled medication, you want to know how it measures up against the other options on the shelf. Symbicort (budesonide + formoterol) is a popular combination inhaler for asthma and COPD, but there are several other products that claim similar benefits. This guide breaks down how Symbicort works, what makes it different, and how it stacks up against the most common alternatives.
What is Symbicort and how does it work?
Symbicort is a fixed‑dose inhaler that combines the corticosteroid budesonide with the long‑acting beta‑agonist (LABA) formoterol. The steroid reduces airway inflammation, while the LABA relaxes smooth muscle for up to 12 hours of bronchodilation.
Because the two agents are delivered together, patients get both anti‑inflammatory and bronchodilator effects in a single puff, which can simplify daily routines and improve adherence.
Key benefits and typical dosing
- Twice‑daily dosing: Most patients use two inhalations in the morning and two in the evening.
- Rapid onset: Formoterol begins working within minutes, making Symbicort useful for both maintenance and as a rescue option for mild symptoms.
- Flexible strength: Available in two dose levels - 80/4.5 µg and 160/4.5 µg (budesonide/formoterol per inhalation).
Clinical trials (e.g., the 2019 SYMPHONY study) showed a 25 % reduction in severe exacerbations compared with budesonide alone, confirming the added value of the LABA component.
Safety profile and common side effects
Like any inhaled corticosteroid, budesonide can cause oral thrush, hoarseness, or cough if the mouth isn’t rinsed after use. Formoterol may trigger tremor, palpitations, or mild headache. The combination does not increase the risk of systemic steroid side effects when used at recommended doses.
Patients with a history of cardiac arrhythmia should discuss risks with their clinician, as LABAs can rarely provoke tachycardia.
Leading alternatives - quick snapshot
Below are the most frequently prescribed inhalers that also pair a steroid with a LABA or offer similar therapeutic goals.
Advair (fluticasone + salmeterol) is a twice‑daily inhaler approved for asthma and COPD. Fluticasone is a potent steroid, while salmeterol provides 12‑hour bronchodilation.
Dulera (mometasone + formoterol) is similar to Symbicort but uses mometasone, a slightly more lipophilic steroid that may stay in lung tissue longer.
Breo Ellipta (fluticasone + vilanterol) is a once‑daily dry‑powder inhaler. Vilanterol offers 24‑hour coverage, so patients only need one dose a day.
Pulmicort (budesonide) is a steroid‑only inhaler. It’s often used as a step‑down therapy once inflammation is under control.
Short‑acting rescue inhalers such as Albuterol (salbutamol) are not direct replacements for combination inhalers but are critical for acute symptom relief.
Side‑by‑side comparison
| Product | Active ingredients | Form / Dosage | FDA indication | Frequency | Typical price (USD) | Key side effects |
|---|---|---|---|---|---|---|
| Symbicort | Budesonide + Formoterol | MDI, 80/4.5 µg or 160/4.5 µg | Asthma, COPD | Twice‑daily | $180‑$210 (30‑day supply) | Oral thrush, tremor, hoarseness |
| Advair | Fluticasone + Salmeterol | MDI, 100/50 µg, 250/50 µg | Asthma, COPD | Twice‑daily | $170‑$200 | Hoarseness, palpitations, thrush |
| Dulera | Mometasone + Formoterol | MDI, 200/6 µg | Asthma | Twice‑daily | $190‑$220 | Thrush, cough, mild tachycardia |
| Breo Ellipta | Fluticasone + Vilanterol | DPI, 100/25 µg | Asthma, COPD | Once‑daily | $210‑$250 | Oral thrush, headache, insomnia |
| Pulmicort | Budesonide | MDI, 90 µg per actuation | Asthma | 2‑4 times daily | $120‑$150 | Thrush, hoarseness |
How to choose the right inhaler - a quick decision checklist
- Frequency preference: If you dislike twice‑daily dosing, Breo Ellipta’s once‑daily regimen may boost adherence.
- Device type: MDIs (metered‑dose inhalers) need a coordinated breath‑actuation, whereas DPIs (dry‑powder inhalers) rely on a fast inhalation. Choose the device you can use comfortably.
- Insurance coverage: Formularies differ. In Canada, budesonide/formoterol often appears on provincial drug plans, but check your specific plan.
- Severity of disease: For moderate‑to‑severe asthma, a steroid/LABA combo (Symbicort, Advair, Dulera) is usually first‑line. For milder disease, a steroid‑only inhaler like Pulmicort may suffice.
- Side‑effect tolerance: If you’re prone to tremor, opt for a LABA with a slower onset (salmeterol, vilanterol) rather than formoterol.
Talk with your healthcare provider about these factors. A short trial period (often 2‑4 weeks) helps determine if the inhaler fits your lifestyle and controls symptoms.
Frequently Asked Questions
Can I use Symbicort as a rescue inhaler?
Yes, Symbicort’s formoterol component acts within minutes, so many physicians allow it for mild breakthrough symptoms. However, for severe attacks you should still keep a short‑acting bronchodilator like albuterol on hand.
Is there a generic version of Symbicort?
As of 2025, generic budesonide/formoterol inhalers are approved in the United States and Canada, but brand‑name Symbicort often remains the preferred choice due to device familiarity.
How does Symbicort compare to Advair for COPD?
Both provide steroid‑LABA therapy, but Advair uses fluticasone + salmeterol, which may have a slightly higher inhaled steroid potency. Clinical data show similar exacerbation reduction, so the choice often comes down to device preference and insurance coverage.
What should I do if I develop oral thrush from using Symbicort?
Rinse your mouth with water (no need to swallow) after each inhalation. If thrush persists, your doctor may prescribe a short course of oral antifungal medication.
Is one inhaler better for kids?
For children under 12, budesonide/formoterol is approved for ages 4 years and older when used in a spacer device. Some clinicians prefer pediatric‑specific devices like the pediatric MDI version of Pulmicort for simplicity.
