What are the inhaled corticosteroid (ICS) and long‑acting β2‑agonist (LABA) strengths and typical adult dosing for Symbicort (budesonide/formoterol)?

Symbicort (Budesonide/Formoterol) Content and Dosing

Symbicort is a fixed-dose combination inhaler containing budesonide (an inhaled corticosteroid) and formoterol (a long-acting β2-agonist), available in multiple strengths with typical adult dosing of 160/4.5 mcg (2 inhalations twice daily) for mild-to-moderate persistent asthma or 320/4.5 mcg (2 inhalations twice daily) for moderate-to-severe persistent asthma. 1

Available Strengths

Symbicort contains two active components in each inhalation 2, 3:

• Budesonide (ICS): 80 mcg or 160 mcg per inhalation 1
• Formoterol (LABA): 4.5 mcg per inhalation 1

The combination is delivered via either Turbuhaler (dry powder inhaler) or pressurized metered-dose inhaler (pMDI) formulations 2, 4.

Standard Adult Dosing Regimens

Mild-to-Moderate Persistent Asthma

• Budesonide/formoterol 80/4.5 mcg: 2 inhalations twice daily (total daily dose: 160/9 mcg) 1
• This represents Step 3 therapy when low-dose ICS alone is insufficient 1

Moderate-to-Severe Persistent Asthma

• Budesonide/formoterol 160/4.5 mcg: 2 inhalations twice daily (total daily dose: 320/9 mcg) 1, 4
• For severe persistent asthma requiring higher ICS doses, budesonide/formoterol 320/4.5 mcg: 2 inhalations twice daily (total daily dose: 640/9 mcg) 1

Maximum Approved Dose

• Up to 640/18 mcg twice daily has been studied in 52-week tolerability trials with a safety profile similar to budesonide alone 4

Clinical Advantages of the Combination

The budesonide/formoterol combination demonstrates synergistic effects when delivered in a single inhaler 3:

• Rapid onset of bronchodilation: Effect apparent within 1-3 minutes due to formoterol's properties 3, 5
• Faster onset than salmeterol/fluticasone: Budesonide/formoterol shows significantly higher FEV1 at 3 minutes compared to salmeterol/fluticasone combinations 5
• Complementary mechanisms: Budesonide treats underlying airway inflammation while formoterol prevents and reverses airway obstruction 2
• Exacerbation reduction: The combination reduces mild exacerbations by 40% and severe exacerbations by 29% compared to ICS alone 1

Administration Guidelines

• Frequency: Twice daily, approximately 12 hours apart 1
• Mouth rinsing: Rinse mouth after each use to prevent oral candidiasis and dysphonia 1
• Spacer use (for pMDI): Consider using a spacer or valved holding chamber to optimize drug delivery and reduce local side effects 1
• Technique verification: Verify proper inhaler technique at each visit before concluding therapy is inadequate 1

Monitoring and Dose Adjustment

• Assess asthma control every 2-6 weeks initially, checking adherence and inhaler technique before adjusting doses 1
• If well-controlled for ≥3 consecutive months, consider stepping down to a lower dose 1
• Increasing rescue SABA use (>2 days/week, excluding exercise prevention) indicates inadequate control and need for step-up therapy 1

Critical Safety Considerations

• Never use as monotherapy: LABA must always be combined with ICS to prevent increased exacerbations and treatment failures 1
• Not for acute relief: Formoterol in Symbicort should not be used for acute symptom relief or exacerbations; maintain separate rescue inhaler 1
• Do not discontinue abruptly: Sudden discontinuation may lead to asthma exacerbation 1
• Begin with the lowest dose appropriate for severity and titrate up only if needed 1