From the Guidelines
Symbicort (budesonide/formoterol) dosage should only be increased under the direction of a healthcare provider, never independently by the patient, when symptoms are not adequately controlled on the current dose, such as experiencing increased wheezing, shortness of breath, nighttime awakenings, or needing rescue inhalers more frequently, as indicated by the most recent guidelines 1. For asthma patients, a dose increase may be recommended when the current dose does not provide adequate control of symptoms, as suggested by the expert panel report 3 (EPR-3) guidelines for the diagnosis and management of asthma 1.
- The standard maintenance dose for asthma is typically 2 inhalations twice daily,
- while COPD patients usually take 2 inhalations twice daily of the 160/4.5 mcg strength. Some asthma patients may be instructed to temporarily increase their dose during worsening symptoms as part of an action plan, but this should always follow pre-established guidelines from their doctor, as noted in the review of national guidelines for management of COPD in Europe 1. Increasing the dose works by delivering more anti-inflammatory corticosteroid (budesonide) and bronchodilator (formoterol) to reduce airway inflammation and relax airway muscles, which is supported by the study on long-acting beta2-adrenergic agonists in the treatment of asthma and COPD 1. Patients should be aware that overuse of Symbicort can increase the risk of side effects including oral thrush, hoarseness, increased heart rate, and tremors, which is why medical supervision is essential for any dosage changes. Key considerations for dose adjustments include:
- Persistent breathlessness or frequent exacerbations despite regular use of the prescribed dose,
- The need for rescue inhalers,
- Nighttime awakenings,
- And the overall control of symptoms, as emphasized by the guidelines 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Increased Dose of Symbicort
- The decision to increase the dose of Symbicort (budesonide/formoterol) for asthma or Chronic Obstructive Pulmonary Disease (COPD) should be based on the patient's response to treatment and the severity of their symptoms 2, 3.
- According to the study by 4, adjustable dosing with budesonide/formoterol via a single inhaler (Symbicort) can provide effective asthma control at reduced medication doses.
- The study by 5 suggests that as-needed budesonide-formoterol can be an effective treatment option for patients with mild asthma, and that the dose can be adjusted based on the patient's symptoms and response to treatment.
- Another study by 6 found that budesonide/formoterol inhalation aerosol (Symbicort) is effective and generally well tolerated in patients with persistent asthma, and that the dose can be adjusted based on the patient's response to treatment.
Dosage Adjustment
- The dosage of Symbicort can be adjusted based on the patient's symptoms and response to treatment, with the goal of achieving optimal control of asthma symptoms while minimizing side effects 4, 5.
- According to the study by 3, adjustable dosing with Symbicort can maintain control of asthma using less medication and is associated with lower treatment costs than fixed dosing.
- The study by 6 found that budesonide/formoterol pMDI administered twice daily is effective and generally well tolerated in patients with persistent asthma, and that the dose can be adjusted based on the patient's response to treatment.
Patient-Specific Factors
- The decision to increase the dose of Symbicort should take into account patient-specific factors, such as the severity of their symptoms, their response to treatment, and their medical history 2, 3.
- According to the study by 5, the effectiveness of as-needed budesonide-formoterol may vary depending on the patient's prestudy treatment, and that the dose should be adjusted based on the patient's symptoms and response to treatment.