Symbicort – frequently asked questions

This post will hopefully clarify some of the many questions that I receive on my Youtube channel about the Symbicort inhaler. I do not claim that Symbicort is better than other inhalers, it just seems to be one of the most frequently used – therefore a lot of questions on this topic seem to come up in the comments. Please search my YouTube channel if you prefer to find some of these and other answers in a video format. I also try to demonstrate an effective inhaler technique in many videos. In no particular order, hopefully the information below will be helpful to you. I have included relevant videos where available.

I can’t taste the medicine – is the inhaler empty? Or not taken correctly?

This is a very common question and really comes down to the fact that in more recent years, there was a move towards a tasteless powder being used in the Symbicort turbuhalers. As far as I understand this is due to the preference of the majority of patients with asthma and COPD to have a tasteless medication being inhaled. I am not 100% sure that is the reason.

In any case, this would mean that even if you may feel a bit of powder in your mouth, it may not taste like “medicine”. This does not mean that it wouldn’t be effective. As long as the effect is as expected (improved breathing, better asthma control etc.) there is no issue.

Theoretically, if you are using correct inhaler technique (see below), you shouldn’t feel much as you are breathing in from the device. However, if you do feel as if there is a lot of “powder” in your mouth, or a “powdery taste”, maybe consider checking with your healthcare provider if you are indeed taking the inhaler correctly.

Is Symbicort the best inhaler?

I never make such claims about any inhaler, including Symbicort. The reason for that is that each patient has a different condition, different preferences for various inhalers, different abilities to inhale correctly from available devices. There may also be issues around cost and affordability.

For these reasons (and possibly many others) I do not generally recommend a specific inhaler for everyone (one size does not fit all).

However, Symbicort is a good, well-known treatment for asthma and COPD (if prescribed to you by your doctor). If you are on a different inhaler and thinking about switching to Symbicort, always check with your doctor first if that is the right strategy for you.

Symbicort contains two medications in the same device (it is a combination inhaler). One medication is budesonide, which is a type of inhaled corticosteroid, acting as an anti-inflammatory medication. Inhaled corticosteroids are used long term to control airway inflammation — this is the main problem in conditions such as asthma. Controlling airway inflammation helps to prevent asthma attacks from occurring, therefore it controls the asthma. The dose of inhaled corticosteroids contained in inhalers is extremely small. The other medication is formoterol, which is a bronchodilator, and acts to open up the airways. Formoterol has interesting properties in the sense that it acts for up to 12 hours, but it’s onset of action is also relatively quick (within minutes), meaning that it can be used as a reliever.

How do I know if I am taking it correctly?

Make sure that you know the correct technique to use your inhaler, as they all vary to some extent. The first thing is to ask the doctor/nurse who prescribed it to show you how to use it. Most doctors will explain the correct technique, but just in case you don’t understand the explanation, ask for further clarification. It also helps to read the instructions provided when you take the inhaler from the pharmacy. In some cases, the pharmacist can also show you how to use it.

The other thing I would recommend is to watch videos on how to use it, and I actually have a few on my channel that I am embedding below:

Or a shorter version:

The other thing I would really recommend is to take the Symbicort inhaler with you to your medical consultations. Then you can actually use it while your doctor/nurse is watching you to get feedback on how you are using it. This may be the best way to improve your inhaler technique. Do not be afraid to take an extra dose during the consultation, usually it is not a problem, your healthcare providers will give you advice on this.

The final thing to consider is that if you are actually feeling better (i.e. your asthma is quite well controlled), you are probably doing a good job of taking it. Do remember to go for regular check-ups with your doctor/nurse even if you are feeling well.

How soon do you feel the effect of Symbicort?

If you are thinking about the immediate effect on relieving breathlessness (i.e. in an asthma attack), Symbicort actually acts relatively quickly (in a matter of minutes if inhaled correctly). See the next question below on how this effect can be integrated into your asthma treatment strategy.

If you are wondering about the long term effects – if you are trying to control asthma for example, it may be that you will need a period of regular use (days-weeks) to notice a decrease in asthma attacks. This can vary depending on how active the airway inflammation is. Other factors may play a role as well: ongoing asthma triggers, incorrect use, refractory asthma, other medical conditions contributing to breathlessness etc. Do check with your doctor as soon as possible if no improvement in your symptoms is noted or if your asthma attacks are worsening.

I have a little video for you with some clarifications on this point:

Can I use Symbicort as a reliever for asthma attacks?

Actually this is possible and a great point. Because one of the medications in the Symbicort inhaler is formoterol (see above), which acts quickly to open up the airways, it can actually be used as a reliever (in addition to being a long term controller inhaler). Symbicort also contains budesonide which is an inhaled corticosteroid (this is the controller component of the inhaler).

Therefore, if you are having an asthma attack, it may mean that you have encountered an asthma trigger which lead to an inflammatory reaction in the airways. By taking an extra dose of controller medication (inhaled corticosteroid) while using it as a reliever (due to the rapid effect of the formoterol), you are actually hitting two birds with one stone (relieving symptoms and getting a controller boost).

So, as an example, someone is using Symbicort twice daily (one puff in the morning and one in the evening) and gets an asthma attack in the early afternoon after cleaning their apartment and inhaling some house dust. They would take an extra puff of Symbicort to stop the asthma attack and this would relieve the symptoms but also deliver a bit of extra controller for that day to prevent further asthma worsening. This is called a SMART strategy (single maintenance and reliever therapy).

This strategy may be suggested by your doctor and can work quite well. It is however likely that you would also be instructed what to do if the Symbicort alone doesn’t stop the asthma attack – i.e. need to use extra Ventolin (salbutamol), a nebulizer, a spacer etc. It depends on your individual situation so do check with you health provider. This strategy does not work for everyone.

My dose counter doesn’t go down – is the inhaler broken?

Very common question I get in the comments. Actually the dose counter on the Symbicort is not as precise as some people would want. It typically goes down in 20s – i.e. 60-40-20. This means that you would need to take quite a few full doses until you will see the number dropping (dial slowly moving to the next number).

I have this short video to explain this situation:

I dropped the inhaler, is it broken?

This was a nice question that I received on my channel and I did answer in the video below. In brief, if it still works as expected and there is no visible damage, it should be fine. However if it has come apart, the bottom part cannot be rotated anymore to activate the inhaler, or if it sounds broken – probably needs a replacement. Do try to use your common sense on this one.

The mouthpiece rotates – is the inhaler faulty?

This is not usually a sign of damage, as the top part of the mouthpiece actually can rotate freely if you twist it. That being said, you probably should not actively try to twist it off as there is no reason to do that. Only the bottom red part needs to be rotated in one direction and then back to activate the inhaler (prior to inhaling).

Do you need to shake Symbicort before taking it?

There is no need to shake it, it just needs to be activated in the usual manner: twist the bottom red part all the way in one direction and then twist it back until you hear a click. At this stage you are ready to inhale the medication. Short video explaining this below:

Finally, in the video below I tried to answer a few other frequently asked questions about this inhaler (which may not be covered above in the text). Hope you found this article useful. Do check with your healthcare provider if you have any issues.

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