Switching from Symbicort to Flovent During Allergy Season is NOT Recommended
Switching from Symbicort (budesonide/formoterol) to Flovent (fluticasone) alone during decompensated asthma control in allergy season is a step backward in therapy and should be avoided. This approach removes the long-acting beta-agonist (LABA) component precisely when you need enhanced bronchodilation, and replaces combination therapy with ICS monotherapy at a time when asthma control is worsening 1, 2.
Why This Switch is Problematic
You are essentially downgrading from Step 3-4 therapy (ICS/LABA combination) to Step 2 therapy (ICS alone) during an exacerbation period, which contradicts fundamental asthma management principles 3.
Loss of LABA Component
- Symbicort contains formoterol, which provides rapid-onset bronchodilation (within 1 minute) and sustained effect over 12 hours 4, 5
- Removing this component during allergy season—when airway inflammation and bronchospasm worsen—eliminates a critical therapeutic benefit 6
- The American Academy of Family Physicians emphasizes that ICS/LABA combinations provide superior symptom control and reduced exacerbation rates compared to ICS monotherapy 1, 2
Inadequate Dose Equivalency
- Flovent 110 mcg × 3 puffs daily = 330 mcg fluticasone daily
- This is roughly equivalent to medium-dose ICS monotherapy 3
- Symbicort provides both ICS AND LABA, making it inherently more effective than any dose of ICS alone for moderate persistent asthma 6
- Studies demonstrate budesonide/formoterol is significantly more effective than even high-dose fluticasone (500 mcg/day) alone in improving lung function and reducing exacerbations 6
What You Should Do Instead
Option 1: Increase Symbicort Dose (Preferred)
The correct approach is to step UP therapy by increasing Symbicort frequency or dose 1, 2:
- Increase to Symbicort 160/4.5 mcg, 2 puffs twice daily (if currently on lower dose)
- Consider SMART protocol: Use Symbicort as both maintenance AND reliever therapy (up to 8-10 puffs/day total for ages ≥12) 1, 5
- This provides both increased ICS and on-demand bronchodilation without needing separate albuterol 1
Option 2: Add Adjunctive Therapy
If already on maximum Symbicort dosing 2:
- Add leukotriene modifier (montelukast 10 mg daily) for allergic component 3, 2
- Continue Symbicort at current or increased dose
- Use albuterol PRN for breakthrough symptoms 3
Option 3: Consider Short-Term Oral Corticosteroids
For true decompensation 3:
- Prednisone 40-60 mg daily for 5-10 days 3
- Maintain or increase Symbicort during and after the burst
- Never discontinue ICS/LABA during exacerbations
Critical Pitfall to Avoid
Never use LABA monotherapy, but equally important: don't remove LABA when asthma is worsening 1. The American Academy of Family Physicians explicitly warns against LABA monotherapy due to increased mortality risk, but the corollary is that removing LABA during poor control is also problematic 1.
Albuterol PRN is Appropriate BUT...
- Albuterol as rescue therapy is standard and appropriate 3
- However, needing albuterol more than 2 days per week indicates inadequate controller therapy 3
- This signals the need to step UP (not switch laterally or down) your maintenance regimen 3
The Evidence Against Your Proposed Switch
Studies comparing ICS/LABA combinations to ICS alone consistently show 6:
- Greater improvements in morning PEF (27.4 vs 7.7 L/min, p<0.001)
- 32% reduction in exacerbation risk with combination therapy
- Better symptom control and fewer reliever-free days with ICS alone
- These benefits persist even when comparing combination therapy to HIGH-dose ICS monotherapy 6
Bottom line: Stay on Symbicort and increase the dose or frequency during allergy season. Switching to Flovent alone removes critical therapeutic components exactly when you need them most 1, 2, 6.