Appropriate Dosing for Symbicort (Budesonide/Formoterol) in Adults and Children Over 12 Years
For adults and children over 12 years with asthma or COPD, the recommended dosing for Symbicort is 160/4.5 μg (two inhalations twice daily) for moderate to severe persistent asthma or COPD, or 80/4.5 μg (two inhalations twice daily) for mild to moderate persistent asthma. 1
Dosing for Asthma
Step-Based Approach
- Symbicort is typically used in Step 3 care or higher for moderate to severe persistent asthma in patients 12 years and older 2
- Symbicort should not be used as monotherapy for asthma; it combines an inhaled corticosteroid (ICS) with a long-acting beta2-agonist (LABA) 2
- For mild to moderate persistent asthma: Symbicort 80/4.5 μg, two inhalations twice daily (total daily dose: 320/18 μg) 1
- For moderate to severe persistent asthma: Symbicort 160/4.5 μg, two inhalations twice daily (total daily dose: 640/18 μg) 1
Alternative Dosing Strategy
- For patients ≥12 years with mild persistent asthma, either daily low-dose ICS with as-needed SABA OR as-needed ICS and SABA used concomitantly can be considered 2
- Based on studies of intermittent ICS dosing, one approach is 2-4 puffs of albuterol followed by 80-250 μg of beclomethasone equivalent every 4 hours as needed for asthma symptoms 2
Dosing for COPD
- For severe and very severe COPD: Symbicort 160/4.5 μg, two inhalations twice daily 3
- This dosing has demonstrated improvements in lung function, respiratory symptoms, health status, reduced rescue medication use, and reduced COPD exacerbations compared to placebo 3
Special Considerations
Maintenance and Reliever Therapy (SMART)
- In some countries, Symbicort is approved for both maintenance and as-needed relief (SMART approach) 4
- Studies show that Symbicort SMART (160/4.5 μg, one inhalation once or twice daily plus as-needed doses) can be as effective as higher fixed doses with separate reliever medication 4
- This approach is currently considered off-label use in the United States 2
Onset of Action
- Symbicort shows a rapid onset of clinically significant bronchodilation (within 15 minutes), which is faster than some other combination ICS/LABA products 5
- Maximum benefit may not be achieved for 4-6 weeks after starting treatment 6
Monitoring and Adjustments
- Regular follow-up is essential to ensure the dosing regimen remains appropriate 2
- Increasing use of rescue medication generally indicates inadequate asthma control and the need for intensifying therapy 2
- When benefits are sustained for 2-4 months, consider stepping down therapy 2
- If there are no clear benefits within 4-6 weeks, consider stopping treatment and exploring alternative therapies or diagnoses 2
Common Pitfalls and Caveats
- Regularly scheduled, daily, chronic use of short-acting beta-agonists is not recommended 2
- Patients with low or high perception of symptoms may not be good candidates for as-needed therapy approaches 2
- Mouth should be rinsed after each treatment to prevent local side effects like oral thrush 7
- Using a spacer or valved holding chamber can improve drug delivery and reduce local side effects 7
Symbicort has shown similar efficacy and tolerability to other ICS/LABA combinations while potentially requiring lower total corticosteroid exposure in some dosing regimens 8.