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symbocort useing SMART system

Hi all

just intrested in knowing if anyone is using symbocort as preventer as well as reliver.

I had appointment with papworth cons i asked about it as im get loads of probs at work when nebs are due normally do ventolin/atro nebs at 7pm but most days lungs start stroppn from 6 onwards n thats teatime for the residents so i cant just go for my break early. So i though the extra steroid might help n even might help so i dont need the neb all the time. But saw allergy con not a lung con n he did not thick it would b any help just said up flixotide neb so we aggreed to uses flix neb 3x aday n use 2puffs of ventolin inh a 5pm when i tryed it the other day it did not help but was very mild weather using flix 3x is helpn abit i need help early eve. Thanks for reading x

2 Replies

Hi Smiler,

The Symbicort SMART system is about using Symbicort as a reliever as well as a preventer (rather than the other way around); the logic behind this is that the long-acting beta-2 agonist in it, formoterol, is fairly quick acting, and can thus be used as a reliever, and this means that increased use of your reliever automatically means that you are getting more inhaled steroid.You can see more information about it here on the drug company's website - (note that the doses are given slightly differently on this site - 80/4.5 is equivalant to 100/6, and so on).

Symbicort SMART is not appropriate for everyone. Only the 100/6 and the 200/6 inhalers are licensed for use in this way, not the 400/6, and it is recommended that a dose of upto 8 puffs a day, or 12 puffs for a short period, is the maximum that is used. This equates to a maximum of 2400mcg of budesonide daily, which is equivalent to 1200mcg of fluticasone (Flixotide). You don't say what dose of Flixotide nebs you are on, but if you are using them three times a day, you must be using at least 1500mcg (1.5mg) as the lowest dose nebs available are 0.5mg. Changing to Symbicort SMART would therefore represent a decrease in your total daily steroid dose. Even adding in Symbicort SMART rather than substituting it would not be expected to be more effective than simply increasing the Flixotide - there is no particular evidence that adding in a second inhaled steroid improves control.

In the same way, if you are on regular nebs, you are obviously requiring reliever medication in excess of the doses provided by the Symbicort SMART system. This suggests that you would simply be using the maximum amount of Symbicort SMART every day (8 or 12 puffs, as recommended by your medical team). This defeats the object of having a flexible dosing system, which is Symbicort SMART's main advantage.

Sometimes it is beneficial to completely change your inhaled steroid and/or long-acting beta-2 agonist - although there is no particular evidence that one is better than the other, some people do find some benefit from changing. This may be something that you wish to discuss with your medical team. However, based on the doses that you seem to be on at the moment, changing to the Symbicort SMART system would not seem to be appropriate. Nebulised or high dose inhaled budesonide (Pulmicort), on its own, for example, would seem to be more appropriate.

I hope this makes sense - please do discuss it further with your medical team.

Take care

Em H


Hi Em H

Thanks yes I did understand your post I posted using mob internet n got error message so was sooooooo please coming on he to find my post had been sent ;)

At the mo I'm on flixotide 500 neb 3x aday then ventolin/atro 3x can go up to 4x was on 4x aday before then started volmax tabs 8mg every 12hrs im taking them at 10am/10pm Before I was doing it at 7am/7pm so thought changing to late might help, but has not :( so wanted to try dropping relivers mainly cos I was concerened about being on max relivers then what happens when get bad. I find tabs help more at night but get loads of tightness around time of evening nebs then get alot of pain in back n rightside had x ray done come back clear. Its just getting a pain but in work from wedesday til sunday so will give this ventolin inh at 5pm ago n see what happens. Then get back to Papworth with how things are.

Take care n Hello to everyone else



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