Symbicort to be liscenced as a reliever?

At the chest clinic the Resparitory nurse was telling me that Symbicort is going to be liscenced as a reliever soon. Apparently after Easter I can take my usual two puffs twice a day and the odd puff in between if I need it. Aparently it has three things in it; the steroid, the long acting reliever and a short acting reliever. I never knew it had a short acting reliever in it too, the first time I was in hospital I was told to take my Bricanyl before I took it to open up my tubes.

Anyone else heard about this or use it as a reliever already?


23 Replies

  • I think the reliever is long acting but works quickly so that is why it can be used as a reliever. Never used it for that myself, but given that it appeared to make me spectacularly worse I'm not a very good example!

  • I was told this was going to happen last year they have just been waiting for the license approval i think it was discussed here a long time ago. havent used it as such though. Will be interesting for PCTs price wise though!

  • Yes! I was told this by the brompton. It contains budesonide and formeterol only, a corticosteroid and long acting B-agonist. I'm not convinced about it replacing salbutamol/terbutaline as they are different drugs. However the long acting reliever in it acts much quicker, within minutes. This is why they recommend to use it for acute situations!

  • Don't use it for myself normally, but whenever I have been in hospital they would sometimes have me take it before or after a neb if I wasn't so good. Thought it was a little weird though.


  • I would be lost without symbicort re daytime control of symptoms and being able to exercise. In this context I've always used symbicort as a short acting reliever med.

    Tried seretide – similar actions to symbicort - but like you Owl it just made me worse, other way round if you know what I mean!

    It was explained to me some time ago about how and why the LABA part of this drug works slightly more quickly than another very similar LABA – salmeterol. I suspect one of the reasons why this drug combination- symbicort- has been licensed for use as a short acting reliever is because of the relatively more ‘safe’ action of the two combined drugs - budesonide and formeterol – rather than just taking formoterol on its own. Salmeterol already has a dodgy reputation in some other countries. However when either of these two LABA’s are combined with any corticosteroid the end results are much safer. Unless you are allergic to either drug that is!

  • Anybody any ideas on how that works if you're already on a high dose?

    I'm currently on symbicort and pulmicort (to keep the formoreterol dose down) and have been told at clinic that the 1600 mg of budesonide is the max licensed dose... so, if it is used as a reliever too... how would that work?

    Must admit, I'm sceptical too as I haven't noticed that it has that sort of effect - I often need to take my salbutamol after taking my other inhalers.


  • Sorry, forgot one other thing....

    When my cons changed me over to symbicort from seretide, my GPs refused to prescribe more than 1 inhaler at a time (due to cost! he wanted to ensure I got on ok with it before prescribing any more) even though each 400/12 dose inhaler only contained 60 doses (15 days) and it was just before the Christmas holiday period, so a real pain - had to get a repeat on 28th December.

    If it is so costly, I can't see my GP being prepared to use it as a reliever as well.....


  • Kat,

    I am on 400/12 two puffs twice daily and I was under the impression that this was the highest dose. I've now been told that when I'm unwell I can take my 400/12 three puffs twice daily (this is before the license comes in) and when the license comes in I can use it as a reliever too.

    Charming that your GP is being funny about the cost! I'm sure the cost of them prescribing it and you being as well a possible is much less costly than you being unwell and having to use lots of other services such as being admitted, A and E, add on medicaitons when you are ill etc. Maybe point that out to them next time? :-)


  • Thanks for your replies everyone its been really useful to know in a bit more detail how it works.

    Surely they must have trialled it as a reliever already if they are starting to market it?


  • I'm on symbicort 400/12 2 puffs twice daily,also was told it was the highest dose i could take!

    dont think it could replace my ventolin though,it doesnt seem to work that quick,i have to use ventolin not long after using the symbicort sometimes.

    I'm having to have a new inhaler every 2 weeks just using it normally so if i was to use extra puffs as well i would get through it even quicker,with there only being 60 metered doses in it.

    mel xxxxxxxxxxxxxxxx

  • hmm, I'm confused. Is oxis going to be licensed as well, seeing as this is the reliever part?

  • Oxis is already licensed as a reliever inhaler, for exactly the reasons Owl mentioned - its onset of action is within a short amount of time (unlike servent, which can have a delayed onset of action).

  • aah, that would make sense! thanks cathbear

  • Mel,

    Oh I hadn't thought about the amount of inhalers we would get through. I'm not sure it would replace my bricanyl/salbutamol inhalers all together but I'm hoping it might calm things down enough not to need as many trips to A and E. Maybe I'm too optimistic! :-)


  • hi beth,

    well you can always hope!

    it just makes you wonder what the docs are on about when they say they want you on the lowest dose possible! then say you can increase if needed hmm!

    when they say your already on a highest dose,


    mel xxxxxxxxxxxxxxxx

  • Hi there,

    I also take 2 puffs bd of symbicort (400/12) and think its fantastic. I was at the chest clinic recently and the reg told me that I can use it as a reliever too. In fact he seemed to be recommending it being used as a reliever.

    I have to admit i don't like the idea of all the extra inhaled steroid doses if i was to use it as a reliever (i know inhaled steroids dont have the same risks as oral) but at the 400/12 dose and being used as a reliever I'd worry about osteoporosis etc (i am a worry wart!) I also find that it requires quite a lot of puff and you cant use it with a spacer.

    So i dont think i'll hang up my ventolin yet!

    Dydd gwyl Dewi Hapus! (Happy st davids day!)

    Cofion lu,


  • Mel,

    Yeah I know what you mean about saying in one breath I can step down and in the next that I can use more. I don't think they know they are only trying to guess and make suggestions. The resp nurse was encouraging me to use more and the Dr (who I've never met before) was encouraging me to use less apart from when I am ill or its grass pollen season. Basically I think that probably means that I'm not going to be well enough for long enough to step down as I'd like to be stable for a couple of months before I stepped down.

    Ah well I'll just have to see what happens. The more things I try the easier it might get to manage! :-)


  • My son was changed from Seratide to symbicort in December by the RBH. He is taking 2 puffs 400/12 twice a day routinely. I was told he could take an additional 2 puffs during each day if he was wheezy (as he is pretty wheezy at some point most days) I initially found he was always needing the extra meds. So now use Ventolin if he is wheezy for exercise or allergy type thing but use symbicort if it looks like an all day/longer term prob. not sure if thats right but it made sense to me! Meant to check at last appointment but caught up talking about Theo levels raising during viral infections!

    hope this throughs some light on subject.


  • I can understand why it is being liscensed to be used as a reliever as i notice a little improvement quite quickly after taking mine , always used to have to take ventolin before inhalers but dont with symbicort,

    The only downside of that for me is i wont be able to use it that way as already over limit on 3 puffs of 400/12 twice a day.

    Its good stuff though i dread to think what i would be like if i was still on previous meds.

    Hope the change is able to help alot more people .

  • Hi Beth and everyone

    another thing I forgot yesterday - if you google symbicort, it throws up a link to an article about the study on using it as a reliever (I think it was a BMJ article)... I found it a couple of weeks ago when I wanted to find out more about side effects etc..

    It does concern me that on the one hand, the max licensed daily dose of budesonide is 1600 mg (although clinics will sometimes prescribe higher) and yet we may be told to use as needed.... doesn't seem to add up to me either.... if the max dose of steroid is 1600 mg, then wouldn't it be better to prescribe the LABA componenet separately for use as and when...

    I will ask that Q next week at clinic if I remember!!!


  • just to say I completely forgot to get to the bottom of this today..... but I am back in clinic in a couple of weeks so will try to remember next time.....

    Clinic was running so late they were giving out free tea and coffee vouchers and so I was late for work (was interviewing candidates for a job today) so big oops... and result was brain completely fuddled with other stuff.

    I then followed on by being too late leaving work to pick the kids up from school, so now owe my OH big time.....

    One of these days I will be organised and on time for something!


  • Quite suprising.

    I certainly wouldn't use Symbicort in place of ventolin during an attack. While Symbicort does work within minutes it's certainly not as fast as ventolin, at least for me. Sounds like the makers of Symbicort getting ahead of themselves here. If they market this as a reliver as well I expect to hear more cases rising of people being admitted to hospital or over dosing on steroids.

  • I've been reading all these messages with interest as i was recently changed to Symbicort. i think as a combo inhalor its really good but i wouldn't fee safe using it during an attack - i feel there are a few too many side effects for the first ten or so mins after using it - after that its great but i def like my salamol easi-breath and MDI with spacer for use in my attacks.

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