Asthma UK community forum

help ...... symbicort smart

im on symbicort 200/6 on the smart programme but have forgotten as this is all new to me do i take my inhaler 8 times a day plus the one in the morning and night or 8 times alltogether ? Also it is giving me a really bad sore throat will this side effect wear off or is it something I have to get used to :-(, I do rinse my mouth out and gargle after taking it , many thanks for your help . donna x

ps im also on ventolin and singulair tablet

6 Replies

That sounds like an awful lot of medication.

The little sticky label that your pharmacist stuck to the side of the Symbicort box will tell you when and how much you need to take. This info may also be shown on your repeat prescription request form.

Failing that, you'll need to go back and see you GP. Everyone's medication is different and it would be dangerous for us to try and advise you further.


the symbicort smart is apparently a new programme so my asthma nurse said and you can take it upto 8 times a day only im not sure if that includes the one in the morning and evening i cant find the bit of paper that she wrote it down on . Thanks for your help, donna


oops thanks for your advice

just as advised checked the box silly me lol, it says on there one click twice a day when required upto 8 times a day ...... i was told to take it 8 times a day , thanks for your advice , take care donna


Symbicort Smart

Hi Donna,

I'm also on the symbicort Smart program using Symbicort 200/6. I take 2 puffs twice a day - 2 in the morning and 2 before bedtime. I can also take one puff inbetween these times if I feel any asthma symptoms starting, but I can't have anymore than a total of 12 puffs in 24 hours which would include obviously the 2 puffs in the morning and the 2 at night. (Hope that makes sense!!

If your having to take as much as this then you should contact either your GP or Asthma Nurse immediately.

Although I don't get a sore throat using this program, I do find I'm always very hoarse, but that is one of the side effects unfortunately. I know it's something we'd rather not have to put up with but it's a small price to pay to have your asthma under control!!! Again, it might be worth having a chat about it with your Asthma nurse or GP if your uncertain about it. I've found the Symbicort Smart program to be very effective for me - I was at my asthma clinic yesterday and had my best breathing test results yet!!! 87% compared to 66% 4 months ago when I was first diagnosed with Asthma.

I know though that everyone is different and while it's worked for me, it's maybe not going to be that way for others. Good luck with it though and I hope things settle down for you and that the program will work for you too. xxx


Hi Donna,

I'm a bit concerned that you seem so unsure about how to use the Symbicort SMART system - your doctor or asthma nurse should have gone through things with you in detail before you started using it, and if this didn't happen, or you didn't understand it, you should go back and have that conversation with them. It's vital that you understand exactly how and when to take your inhaler, and also that you have your inhaler technique checked to ensure that you are using it properly. Without doing those things, you stand little chance of getting your asthma under control, whatever medication you are on.

The Symbicort SMART system uses the standard Symbicort inhaler, which is a combination inhaler containing budesonide, an inhaled steroid, and formoterol, a long acting beta agonist - similar to salbutamol (Ventolin), but with a longer duration of action. Only the 100/6 and 200/6 dosage inhalers are licensed to be used as Symbicort SMART (when talking about dosages, it's worth noting that in the US and some other countries, the 100/6 is referred to as 80/4.5, and the 200/6 is referred to as 160/4.5 - it is the same dose, just with a slightly different component of the active drug being measured).

Symbicort SMART is designed to be used regularly every day as a preventer inhaler, at whatever dose your doctor has recommended - commonly one to two puffs twice daily. This should be taken all the time, regardless of whether your asthma is troubling you. In addition to this, the inhaler can be used as a reliever inhaler - extra doses can be taken during the course of the day if you have symptoms of wheeze, cough or breathlessness, and taking it should quickly make you feel better. The manufacturers, and the BNF, suggest that upto 6 puffs can be used at any one time, and upto 8 puffs can be used daily, or upto 12 puffs daily for a limited period of time under strict medical supervision. This 8 puffs - or 12 puffs - would include the regular morning and evening dose - so if you are taking one puff twice a day, regularly, you could then take up to 6 puffs during the day for symptoms. If you do not have symptoms during the day, you do not need to take extra doses at all, and should just take your normal morning and evening dose. Obviously, though, regardless of the BNF limits and the manufacturers recommendation, you should take Symbicort SMART in accordance with what your own doctor has told you - different people need different doses, and it would be dangerous to try to guess what your doctor is wanting you to do with Symbicort SMART.

The advantage of taking Symbicort in this way is that when you use extra doses of it as a reliever, you are getting a higher dose of the steroid, as well. In the past, asthma management has focussed asking people to increase the dose of their inhaled steroid when they are more unwell with their asthma - however, although this should work in theory, in practice it is difficult to show a benefit. One reason for this could be because it is taking people a few days to realise that their asthma has got worse and they are using more of their reliever, so they are not increasing their steroids soon enough. With the Symbicort SMART system, the process is automatic - if someone uses more reliever, they cannot help but increase their steroid dose too. Studies do appear to have shown a beneficial effect with the Symbicort SMART system, so it would appear that this strategy does help.

Normally with the Symbicort SMART system, you should use the Symbicort inhaler as your sole reliever inhaler. You may be prescribed another reliever, such as salbutamol (Ventolin), to use if you exceed the 8 puffs a day of Symbicort that you are allowed, but you should not regularly be using another reliever as well as Symbicort, unless you have discussed this with your doctor. If you are needing 8 or more puffs of Symbicort, with or without another reliever, on a regular basis, you need to see your doctor or asthma nurse as soon as possible to discuss this, as this suggests that your asthma is not very well controlled, which is a potentially dangerous situation. If at any point you use your Symbicort and it does not help your symptoms or make you feel better, again, you need to seek urgent medical help. Failure of your reliever medication to work is a sign of a serious attack which may need further treatment.

You can see more information about the Symbicort SMART system at

Hope this helps, and that you find Symbicort SMART useful for controlling your asthma.

Take care,

Em H


I take 8 puffs a day.. maximum 12. So I take 2 puffs ... 4 times a day. It's a mission trying to remember to take it! I was so used to morning and evening.

Hope you have managed to sort it out! Sounds like you are on the same dose as me.


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