new symbicort inhaler


I've just been changed from seretide to the new symbicort inhaler. The asthma nurse said that when my asthma was playing up i can have up to 12 puffs in a day to relieve my symptoms. Does this mean i cant take salbutamol if i need it? or do i take it if my symptoms haven't improved after a couple of puffs of the symbicort?

It probably sounds a stupid question but i hope someone can help

23 Replies

  • Well, i think all doctors do it differently. My doctor for instance, makes me take the symbicort 8 times a day, meaning that if my asthma is getting worse i can take upto 4 puffs every morning and night. However, he makes me take the salbutamol whenever needed. The point with the new symbicort SMARt is that you wont have to take your salbutamol at all, so if thats the plan that you and your doctor has, you are not supposed to take the salbutamol at all. But I would keep my salbutamol handy just incase you find that the symbicort doesnt work in an emergency or something. Im not an expert though, so you should probably just call up your doctor and ask him.

  • Hi

    I'm not on it myself but have read a bit about it on the internet. Apparently (please someone correct me if I'm wrong) you take your prescribed dose morning and evening and then should you feel symptomatic, take a puff every 5 mins up to your max 12 puffs. If this doesn't improve things you should seek further help. This should be instead of using your blue salbutamol inhaler.

    Hope that helps


  • Yep that right...max 12 puffs in 24 hours!

  • See the Astra-Zeneca website for more details on Symbicort SMART at

    Basically as far as I can see its just an alternative way of making sure you titrate up your steroid inhaler at times when your control is less good and you are using more of your reliever inhaler - because the two are combined, you can't use more of your reliever without getting more steroid too. Quite a good idea, I suppose, as it's possible to be deteriorating and using more of your reliever before you really realise that you are getting worse - so this method ensures that the increased dose of steroid happens automatically before you necessarily even realise that your control is worse.

    Studies do seem to suggest that Symbicort SMART dosing method does improve control compared to using Symbicort in the old way (it's the same inhaler, just used in a different way), even though nowadays its not really generally thought that increasing inhaled steroids when bad is particularly useful. Perhaps it is because the increase can happen more rapidly - rather than waiting till you notice that your control is worse, and then making the decision to increase, which could take a day or two.

    If you have had your twelve doses of Symbicort in one day and are still needing your reliever, using salbutamol as well won't do any harm - there is no real reason why the two can't be used together - but if you are needing that much reliever and this is a new thing that your doctor isn't aware of, you should seek medical advice. Using more than twelve doses in a day would certainly imply that your control was poor, perhaps dangerously so, so you should check it out with your doctor.

    If you are in doubt about any of this, do please check back with your GP or asthma nurse - she should really have explained it to you fully to begin with!

    Hope this helps and you find the Symbicort useful

    Em H

  • Am i right in saying that the SMART is only available in 200/6 and taht this new system isnt for the 400/12 inhaler?

  • yep!

  • Hopalong,

    I take 400/12 and have been told by my consultant I can use it as and when now it is liscenced. I found it really helpful when I got a horrible cold that went to my chest a few weeks ago. It kept me from needing to visit A and E which usually happens. In my asthma plan I can step up to three puffs twice a day and then as and when needed on top of that.


  • Hi Turtle

    How are you finding the new inhaler? Do you notice any different to Seretide? Does anyone know whether this inhaler will eventually take over from seperate preventer & relievers?


  • i dont think anyone knows, since it is quite hard to predict the future. I wouldnt think so though because i dont think it works as well for everyone.

  • Symbicort Study

    Date: 14 Oct 07 14:10

    Hello to all of you. I have just joined this sight and thought I would put in my twopennorth. You may or may not know that there is a study happening on the use of sSmbicort as a single inhaler. My Dr's practise has asked if I would join and I have agreed. I am not yet on Symbicort and am to start it in 10 days time. Meanwhile I am using my usual Seretide 2 x daily and Bricanyl instead of Ventolin until then. This is for 2weeks in total, and I fill in a diary about how I am and how many attacks I have had and how much Bricanyl I have had up to a set amount per day, then to see the Dr/Nurse, use the Symbicort for 13 weeks and go visit as above,then another 13 weeks. The result of the study is planned for 2009. there are apparently I think she said 8,000 peoplein 12 countries to take part and over 1,000 of them are in this country.When I start the Symbicort I am not to use any other inhaler. If I need more than the maximum amount I have to see them or get in touch straight away. I also have to carry a card to say I am on this and doing a study. Is anyone else doing this or are you just on the Symbicort? Looking forward to reading more. Mo

  • more.

    Hi again turtle,

    I had a fun weekend and ended up seeing the Dr yesterday. From what he said with the symbicort you should not need to take the reliever as you use the S as a reliever. Personally if I needed that much reliever I would be seeing someone, because I know I shouldn't be needing that much if I'm under control. Keep in touch cos I will be starting symbicort myself in 8 days.

    all the best with it Mo

  • symbicort

    Hi All,

    My daughter has been prescribed this today and needs to use this instead of her atrovent and serotide. She has to take 2 puffs of 200/6 morning and night and was told then to use it 4 more times in the day if needed. The doctor then said that if she was still struggling to use her ventolin.

    How have people found symbicort as i believe it is meant to be much faster acting.



  • I'm not sure that the reliever component of Symbicort (formoterol) is particularly faster acting than salbutamol - they are both very fast acting relievers. As I understand it, where formoterol differs is that it is both fast acting, in the way that salbutamol is, and long lasting, in the way that salmeterol is. This means that it can be used as a preventative strategy along with a steroid inhaler in the way that Seretide (salmeterol and fluticasone) is, and as a reliever in the same way that salbutamol is.

    That's my understanding of it anyway.


  • Symbicort Study

    to any interested people out there.

    I have today started on Symbicort for the study they are doing. I am to take 2 doses 2xdaily and then use as a reliever as necessary. It was off to a good start with my peak flow improving by 30 within 15 mins. and no extra dosage at all today, which is good because I have been taking Bricanyl quite a bit over the last 10 days as I had a flare up and have also been on steroids for a week. I was able to go into town without getting too breathless despite the cold wind so all in all not too bad.

    Watch this space!!!

  • seems a high dose does that. But i got told that symbicort is the new drug of choice between gp's. This is coming from the asthma nirse from the practice i am with. Personlly i still prefer the becotide inhaler.

    but i use the brycanyl inhalers alongside the symbicort ones and i still use it aswell if i have any episodes throughout the day.

  • Critty

    What seems a high dose? Mo Seniors regime sounds perfectly normal to me, in fact you seem to be taking higher doses using bricanyl in addition to Symbicort. As previously mentioned the new inhaler is preventer and reliever combined and recommended usage is 2 puffs morning and evening and then as required up to a total of 12 usages in one day.


  • I agree Mo Senior's dose does not seem especially high, particularly as it's probably the 200/6 inhaler that's being used.

    The dose described works out at a total of 800mcg of budesonide daily - the BNF maximum recommended dose of budesonide is 1600mcg and some respiratory physicians will go higher.

    The protocol for Symbicort SMART dosing regimen clearly states that you can use upto 8 puffs a day, or upto 12 puffs a day with the agreement of your medical team, if it is required to control your symptoms.


  • sorry i was reffering to turtles post. Mo senior's is similar to what mine is but i take three puffs twice daily of the symbicort plus the brycanyl as i need it. This is to maintain my peakflow of 650.

  • Critty, the difference is that Turtle is taking Symbicort under the Symbicort SMART regimen, which you clearly are not.

    The Symbicort SMART regimen involves using Symbicort as an immediate reliever of symptoms, as well as taking it twice a day for maintenance asthma control, and it is designed to be used for upto 8 puffs a day, or upto 12 with the agreement of the patient's team - so Turtle is not really on a larger dose than is allowed by the regimen.

    If you are using Symbicort as a preventer, and taking a separate reliever, obviously you will be using less of it, and only taking it twice a day.


  • As I understand it (please correct me if I'm wrong) but mo Senior is on the Symbicort SMART trial and is therefore using the inhaler on the same regime as Turtle.

  • symbicort


    My 15 year old daughter has just been put on symbicort instead of seretide and atrovent as her asthma is being extremely difficult at the moment.

    She has the 200/6 and has been told to take it twice in morning twice at night and then up to 4 more times during day. If she is still struggling she is to take her ventolin using the 10 puffs system if she is really struggling.


  • symbicort study

    Hi guys,

    It's been nteresting reading all the messages since I last wrote. From what they explained to me the study is using Symbicort only and ultimately they want to see what the optimum dose is as a daily dose when using symbicort in this way

    critty, yes it was the higher dose they recommended I take, in the 2 weeks before starting the symbicort I was given bricanyl instead of ventolin but it didn't seem so effective for me. I have had an extra puff of symbicort on 2 seperate days so far which isn't bad I thought. A peak flow of 650. mine has never been that high since I was diagnosed. At present it fluctuates between 350 and 400, but I did have a flare up just before starting the study. I am monitoring the difference before and after for my own amusement it's interesting to say the least.

    emma, I love to read your messages, they are always encouraging as you are so knowledgable. It's nice to have someone who can explain things Ta

    regards to all Mo

  • I use Symbicort 400/12 as my prentor and have done for a couple of years. I have 2 puffs morning and night, and when my asthma is unstable, GP recommends that I double this up. I find the Bricanyl for me, loads more effective than either ventolin or serotide, but imagine everyone gets on better with different meds.

    T x

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