Health Centres - Symbicort
How does it work?
Symbicort turbohaler contains two active ingredients, budesonide and formoterol fumarate (previously known as eformoterol fumarate in the UK) .
Budesonide is a type of medicine known as a corticosteroid. Corticosteroids are hormones that are produced naturally by the adrenal glands. They have many important functions, including control of inflammatory responses. Budesonide is a synthetic corticosteroid and is used to decrease inflammation in the lungs. (NB. Corticosteroids are often simply called steroids, but it should be noted that they are very different from another group of steroids, called anabolic steroids, which have gained notoriety because of their abuse by some athletes and body builders.)
When budesonide is inhaled into the lungs it is absorbed into the cells of the lungs and airways. Here it works by preventing the release of certain chemicals from the cells. These chemicals are important in the immune system and are normally involved in producing immune and allergic responses that result in inflammation. By decreasing the release of these chemicals in the lungs and airways, inflammation is reduced.
In asthma, and in chronic obstructive airways disease (COPD) such as chronic bronchitis, the airways tighten due to inflammation and can also be blocked by mucus. This makes it difficult for air to get into and out of the lungs. Budesonide is used in asthma and COPD to prevent the inflammation and excess mucus formation, and therefore help prevent asthma attacks and shortness of breath.
Formoterol is a type of medicine called a long-acting beta 2 agonist or bronchodilator. It works by acting on receptors in the lungs called beta 2 receptors. When formoterol stimulates these receptors it causes the muscles in the airways to relax. This allows the airways to open.
In asthma and COPD there is narrowing of the airways. By relaxing and opening the airways, formoterol makes it easier to breathe. Formoterol starts to work in one to three minutes and its effects last for about 12 hours.
Inhaling the medicines allows them to act directly in the lungs where they are needed. It also reduces the potential for side effects in other parts of the body, as the amount absorbed into the blood through the lungs is lower than if it is taken by mouth.
The turbohaler does not require co-ordination of pressing a canister and breathing in at the same time, like metered dose inhalers do. Instead, you simply breathe in through the mouthpiece of the turbohaler and the medicine will follow the inhaled air into the lungs. You may not taste or feel the medicine as it is inhaled. It is important to breathe in forcefully and deeply through the mouthpiece to ensure that an optimal dose is delivered to the lungs. Never breathe out through the mouthpiece. You can get more advice from your doctor, asthma nurse or pharmacist on using the turbohaler.
What is it used for?
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Asthma.
Symbicort can be used in one of two ways in the treatment of asthma. It can be taken regularly to prevent asthma attacks (maintenance therapy), with a separate reliever inhaler (eg salbutamol) used to relieve asthma attacks. Alternatively, it can be used regularly to prevent asthma attacks AND used as a reliever when needed to relieve asthma attacks (maintenance and reliever therapy). The maintenance and reliever approach is only suitable for adults aged 18 years and over using the Symbicort 100/6 or Symbicort 200/6 strengths.
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Chronic obstructive pulmonary disease.
Symbicort is used for people with severe COPD who have repeated attacks of breathlessness, despite regular use of long-acting bronchodilators such as formoterol or salmeterol.
Only the Symbicort 200/6 and 400/12 strengths are suitable for treating COPD.
Warning!
- Follow the printed instructions you have been given with this medicine carefully. You should breath in forcefully and deeply through the mouthpiece of the turbohaler to ensure the correct dose reaches the lungs. You may not taste or feel any medication when using the turbohaler, as only a small amount of medicine is released. Never breath out through the mouthpiece.
- Inhaling corticosteroids can sometimes cause a fungal infection called in the mouth called oral thrush. To minimise the risk of this, you should rinse your mouth with water after each time you use this inhaler. Consult your doctor if you develop white patches in your mouth or throat, as these are symptoms of thrush and it may need to be treated.
- Don't exceed the dose of this medicine that your doctor has recommended you use.
- If you have been prescribed Symbicort turbohaler as maintenance and reliever therapy for asthma, you should make sure you carry it with you at all times so you can use it to relieve an asthma attack if needed. If you have been prescribed a separate reliever inhaler you should make sure you carry that with you at all times to relieve shortness of breath if needed.
- If you need to use your reliever medicine (either your separate reliever inhaler, eg salbutamol, or your Symbicort turbohaler) more frequently, or if it becomes less effective at treating attacks, you should consult your doctor because this may indicate that you are having a flare-up of your asthma or COPD, or it is getting worse.
- You should not suddenly stop using this medicine, even if you don't currently have any symptoms, unless your doctor tells you otherwise. This is because stopping maintenance treatment is likely to make your asthma/COPD symptoms return.
- Inhalers may cause an unexpected increase in wheezing and difficulty breathing (paradoxical bronchospasm) straight after using them. If this happens, don't use the inhaler again, use a separate reliever inhaler to open your airways and consult your doctor immediately.
- Inhaled corticosteroids have considerably fewer side effects than steroids taken by mouth. However, when taken for long periods of time at high doses, inhaled steroids do have the potential to cause side effects such as glaucoma, cataracts, thinning of the bones, slowed growth in children and adolescents, and to suppress the functioning of the adrenal glands (glands that produce natural steroid hormones). For this reason your doctor will prescribe the lowest effective dose to control your symptoms, and monitor for these side effects. Do not exceed the dose of this medicine that your doctor has prescribed for you. It is recommended that children receiving long-term treatment with corticosteroids have their growth monitored. If a child's growth appears to be slowed your doctor may refer them to a paediatrician. For further information talk to your doctor or pharmacist.
- People with severe asthma should have regular blood tests to monitor the amount of potassium in their blood. This is because low oxygen levels in the blood (hypoxia) and various asthma medicines, including this one, can potentially lower blood potassium levels.
Use with caution in
- Severe liver disease.
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Diabetes.
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Thyrotoxicosis.
- Tumour of the adrenal gland (phaeochromocytoma).
- Heart disease characterised by thickening of the internal heart muscle and a blockage inside the heart (hypertrophic obstructive cardiomyopathy).
- Narrowing of the main artery that leaves the heart to supply blood to the body (aortic stenosis).
- Fast, abnormal heart rhythms (tachyarrhythmias).
- Abnormal heart rhythm seen on a heart monitoring trace as a 'prolonged QT interval'.
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Heart disease caused by inadequate blood flow to the heart.
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Severe cardiovascular disease.
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Severe heart failure.
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Very high blood pressure .
- A weakening in the wall of an artery that causes it to bulge outwards (aneurysm).
- Untreated low potassium blood levels (hypokalaemia).
- Fungal or viral infections in the airways.
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Tuberculosis affecting the lungs.
Not to be used in
- Known sensitivity or allergy to any ingredient.
- Symbicort 100/6 turbohaler is not recommended for children under six years of age. Symbicort 200/6 and 400/12 turbohalers are not recommended for children under 12 years of age.
This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.
Pregnancy and breastfeeding
Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.
- It is important that asthma is well controlled in pregnant women. Wherever possible, asthma medications should be taken by inhaler, as this minimises the amount of medicine that enters the bloodstream and crosses the placenta. This medicine should be used with caution during pregnancy. Seek medical advice from your doctor.
- In general, asthma inhalers can be used as normal during breastfeeding, because the amount of medicine that passes into the breast milk after using an inhaler is negligable and unlikely to harm the baby. However, it is not known if the medicines in this inhaler pass into breast milk and you should seek medical advice from your doctor before breastfeeding while using this medicine.
Label warnings
- Do not stop taking this medication except on your doctor's advice.
- Follow the printed instructions you have been given with this medication.
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