Can Symbicort (budesonide/formoterol) be used as needed for acute relief of shortness of breath in a patient with asthma or Chronic Obstructive Pulmonary Disease (COPD)?

Can Symbicort Be Used As Needed for Shortness of Breath?

No, Symbicort (budesonide/formoterol) is NOT indicated for acute relief of shortness of breath and should not be used as a rescue inhaler. 1

FDA-Approved Indications

Symbicort is explicitly labeled with the limitation: "NOT indicated for the relief of acute bronchospasm" for both asthma and COPD. 1 The medication is approved only as:

• Maintenance therapy for asthma in patients 6 years and older, administered as 2 inhalations twice daily (morning and evening, approximately 12 hours apart) 1
• Maintenance treatment of airflow obstruction in COPD (160/4.5 strength only), also dosed twice daily 1

What to Use Instead for Acute Shortness of Breath

For immediate relief of acute breathlessness, patients should use an inhaled short-acting beta2-agonist (SABA) such as albuterol/salbutamol. 2, 1

• First aid providers should assist patients with asthma who are having difficulty breathing with administration of their own prescribed bronchodilators (SABAs) as needed 2
• The FDA label specifically instructs: "If asthma symptoms arise in the period between doses, an inhaled, short-acting beta2-agonist should be taken for immediate relief" 1
• Patients must be provided with a separate rescue inhaler and instructed in its proper use 1

Critical Safety Warnings

Patients using Symbicort should not use additional long-acting beta2-agonists (LABAs) for any reason, and more frequent administration than prescribed is not recommended. 1

• More frequent administration or higher numbers of inhalations than 2 inhalations twice daily increases the risk of adverse effects from formoterol 1
• The formoterol component is a LABA designed for maintenance bronchodilation, not acute rescue 1
• Using Symbicort as needed would expose patients to unnecessary corticosteroid doses while failing to provide optimal acute relief 1

Optimal Delivery Method for Rescue Bronchodilators

When assisting someone with acute asthma and shortness of breath, it is reasonable to use either an inhaler with a spacer or a nebulizer, in preference to using an inhaler alone. 2

• Spacer devices improve delivery of bronchodilator medications to the lungs and provide clinical effectiveness equal to nebulizer machines 2
• If a commercial spacer is unavailable, an improvised spacer made with a 500-mL plastic bottle or 150-mL disposable paper cup provides similar drug delivery 2

Common Pitfall to Avoid

The most critical error is patients attempting to use Symbicort for acute symptom relief instead of their prescribed SABA rescue inhaler. 1 Healthcare providers must explicitly educate patients that:

• Symbicort is a maintenance medication only, taken twice daily regardless of symptoms 1
• Decreasing effectiveness of their short-acting rescue inhaler or needing more rescue inhalations than usual requires immediate medical attention 1
• Patients should never stop Symbicort without physician guidance, as symptoms may recur after discontinuation 1

Role in COPD Maintenance

For COPD specifically, Symbicort 160/4.5 reduces exacerbations when used as scheduled maintenance therapy (not as needed), with studies showing 26-35% reduction in annual exacerbation rates compared to formoterol alone. 1 However, this benefit only occurs with regular twice-daily dosing, not as-needed use. 1