✓ Medically reviewed by · Last reviewed: May 2026
Pharmacy Researcher · 8 years experience
Pharmacy researcher with 8 years reviewing clinical drug information, generic formulation equivalence, and international pharmaceutical standards. Focuses on patient-facing accuracy in medication education.
Symbicort is one of the most widely prescribed combination inhalers in the world — but most people who use it could not tell you what is actually inside it, why it is taken every day even when breathing feels normal, or that the same two active drugs are available as a generic for a fraction of the brand price. This guide answers all of that in plain English: what Symbicort is, how the budesonide and formoterol inside it work, the dose strengths, the increasingly popular SMART/MART regimen, side effects and how to avoid the common ones, and how Symbicort compares with the alternatives — including its direct generic equivalent.
Key Takeaways
- Symbicort is a two-in-one preventer inhaler containing budesonide (an inhaled steroid that calms airway inflammation) and formoterol (a long-acting bronchodilator that keeps airways open for ~12 hours).
- It is a maintenance (controller) inhaler — taken every day, even when you have no symptoms — not a stand-alone rescue inhaler.
- Because formoterol starts working within minutes, Symbicort can double as your reliever in the SMART/MART regimen — one inhaler for both daily control and as-needed relief.
- The international brand is made by AstraZeneca; the identical budesonide/formoterol combination is sold generically (for example, Foracort by Cipla) at a much lower cost.
- The single most important habit: rinse your mouth and spit after every dose to prevent oral thrush and a hoarse voice.
What Is Symbicort?
Symbicort is a combination inhaled corticosteroid / long-acting beta-agonist (ICS-LABA) inhaler used to control asthma and chronic obstructive pulmonary disease (COPD). Each puff delivers two medicines at once:
- Budesonide — an inhaled corticosteroid (ICS). This is the “preventer” component. It reduces the underlying inflammation, swelling and mucus in the airways that make them twitchy and prone to narrowing. Its effect builds gradually over one to two weeks of consistent use, which is why daily dosing matters even on good days.
- Formoterol — a long-acting beta-2 agonist (LABA). This relaxes the smooth muscle around the airways and holds them open for around 12 hours. Crucially, formoterol is also fast-acting, beginning to work within 1–3 minutes, which sets it apart from older LABAs such as salmeterol.
Combining an ICS and a LABA in one device delivers better asthma and COPD control than either drug alone, improves adherence (one inhaler instead of two), and — importantly — protects against the safety risk of taking a LABA on its own. Used without a steroid, a LABA carries a recognised increased risk of severe asthma attacks, which is why a LABA should never be used as a solo controller. Symbicort builds the steroid in by design. If you only need the steroid component, that is available separately as budesonide (Budecort).
Symbicort is part of the wider family of combination asthma inhalers, and it sits alongside relievers, preventers and add-on therapies in the broader asthma and COPD treatment category.
How Symbicort Works
Asthma and COPD both involve two problems at once: inflamed, over-reactive airways and narrowed airways from muscle tightening. A single-action drug only tackles one of those. Symbicort tackles both:
- The budesonide works slowly and continuously. It switches off inflammatory signals inside the airway lining, reduces the number of inflammatory cells, calms mucus production and gradually restores how well your airways respond to bronchodilators. This is the part that prevents attacks before they start — but only if taken every day.
- The formoterol works quickly and lasts. It binds beta-2 receptors on airway muscle and relaxes them, opening the airway. Because it acts within minutes yet lasts about half a day, it both relieves immediate tightness and provides 12-hour background bronchodilation from a twice-daily dose.
That fast-on, long-lasting profile of formoterol is the pharmacological reason Symbicort can be used as both a maintenance and a rescue inhaler — something we explain in the SMART/MART section below.
Symbicort Dose Strengths Explained
Symbicort comes in two device types and several strengths. Strengths are written as budesonide micrograms / formoterol micrograms per dose. The most familiar is the Symbicort Turbohaler, a breath-activated dry-powder inhaler:
| Strength (labelled) | Delivered dose (approx.) | Typical use |
|---|---|---|
| 100/6 Turbohaler | ~80 / 4.5 mcg | Mild asthma; lower-dose maintenance and MART |
| 200/6 Turbohaler | ~160 / 4.5 mcg | Moderate asthma; the most common MART strength |
| 400/12 Turbohaler | ~320 / 9 mcg | Higher-dose maintenance only — not used as a reliever |
There is also a pressurised metered-dose inhaler (pMDI) version — a traditional “press-and-breathe” aerosol — in lower-strength options such as 100/3 and 200/6, useful for people who struggle with the fast inhalation a dry-powder device needs, and for use with a spacer. Your prescriber chooses the strength and number of puffs based on whether you have asthma or COPD, how severe it is, and whether you are on a conventional fixed-dose schedule or a MART regimen. A common asthma maintenance dose is one or two puffs twice daily; the exact figure should always come from your treatment plan. You can see current strengths and packs on the Symbicort Turbohaler product page.
The SMART / MART Regimen — One Inhaler for Control and Relief
This is the feature that genuinely sets Symbicort apart, and it is the part most short product descriptions skip. MART stands for Maintenance And Reliever Therapy; the original Symbicort-specific version is called SMART (Symbicort Maintenance And Reliever Therapy).
In a conventional regimen you take a preventer every day and carry a separate blue salbutamol reliever for symptoms. In MART, a single ICS-formoterol inhaler does both jobs: you take your regular maintenance puffs, and you also use the same inhaler whenever symptoms flare instead of reaching for a separate reliever.
Why does this work with Symbicort but not with every combination inhaler? Because the reliever has to act fast. Formoterol does — within a few minutes — so it can safely substitute for a rescue inhaler. Salmeterol, the LABA inside Seretide, is slow to start, so Seretide can never be used this way. If you have ever wondered why one combination inhaler is “MART-approved” and another is not, the onset speed of the LABA is the answer.
The practical payoff: every time you use your reliever, you also get a dose of anti-inflammatory steroid exactly when your airways are inflamed. Large studies show this approach reduces severe asthma attacks compared with using a fast reliever alone. MART is only appropriate with specific strengths (the 100/6 and 200/6, never the 400/12), follows defined daily maximums, and must be set up by a clinician — it is not something to improvise. For the difference between a daily preventer and an as-needed rescue device in general, see our rescue inhaler guide.
Research Spotlight
The landmark SYGMA 1 and SYGMA 2 trials (published in the New England Journal of Medicine, 2018) tested budesonide-formoterol used as needed and as MART in mild asthma. As-needed ICS-formoterol cut severe exacerbations dramatically compared with using a short-acting reliever alone, while exposing patients to far less total steroid than fixed daily dosing. On the strength of evidence like this, global asthma guidelines (GINA) shifted to recommending an ICS-formoterol combination — rather than a reliever-only approach — as a preferred strategy across a wide range of asthma severities.
How to Use a Symbicort Turbohaler Correctly
Technique matters more than people realise — a large share of “inhaler not working” complaints are actually inhaler-technique problems. For the Turbohaler dry-powder device:
- Unscrew and remove the cap and hold the inhaler upright (mouthpiece up).
- Twist the coloured base as far as it will go in one direction, then back until it clicks. That click means a dose is loaded. (For a brand-new inhaler, prime it as the leaflet directs.)
- Breathe out gently, away from the inhaler — never into it, as moisture clogs the powder.
- Seal your lips around the mouthpiece and breathe in forcefully and deeply. A dry-powder inhaler relies on your own fast inhalation to pull the dose in.
- Hold your breath for about 10 seconds, then breathe out slowly.
- If a second dose is needed, repeat the twist-and-click step.
- Replace the cap, then rinse your mouth with water and spit it out. This step prevents thrush and hoarseness.
The Turbohaler has a dose counter — when it shows zero, the inhaler is empty even if it still rattles (the rattle is a drying agent, not medicine). With a pMDI version, a slow steady inhalation and a spacer improve delivery.
Who Should Use Symbicort?
Symbicort is generally appropriate for:
- Asthma that is not controlled on an inhaled steroid alone — when you still have symptoms or attacks despite a regular preventer, a combination inhaler is the usual step up.
- People who would benefit from a single-inhaler MART approach, simplifying maintenance and relief into one device.
- COPD with ongoing symptoms or repeated flare-ups, where an ICS-LABA reduces exacerbations in appropriate patients.
It is not a first reach for very mild, occasional symptoms managed by other strategies, and it is not a stand-alone rescue inhaler outside of a properly set-up MART plan. A clinician should confirm the diagnosis and choose the regimen.
Side Effects of Symbicort
Most side effects are mild, local and avoidable with good technique. They fall into two groups, reflecting the two drugs:
From the budesonide (steroid) — usually local:
- Oral thrush (candidiasis) — white patches in the mouth or throat. Largely preventable by rinsing and spitting after each dose, and by using a spacer with the pMDI.
- Hoarse voice (dysphonia) and throat irritation.
- Cough or a dry mouth shortly after inhaling.
From the formoterol (bronchodilator) — usually systemic but mild:
- Fine tremor (often in the hands), palpitations or a faster heartbeat, especially when starting.
- Headache, and occasionally muscle cramps.
Less common and worth knowing about: at high doses over long periods, any inhaled steroid can have body-wide effects — relevant ones include effects on bone density, a small risk of cataracts or raised eye pressure, and, rarely, adrenal suppression; in COPD, ICS use carries a modestly increased pneumonia risk. A rare but important reaction is paradoxical bronchospasm — wheezing or tightness immediately after a dose — which means stop and seek advice. The guiding principle is to use the lowest dose that keeps you well, reviewed regularly with your prescriber, who may step you down to a steroid-only inhaler if control allows.
Symbicort vs the Alternatives
Symbicort is one of several combination and single-agent inhalers. The right choice depends on the molecules, the device, and whether you want MART capability. Here is how the main options compare:
| Inhaler | Active ingredients | MART-capable? | Notes |
|---|---|---|---|
| Symbicort | Budesonide + formoterol | Yes | The original ICS-formoterol combination; brand by AstraZeneca |
| Foracort | Budesonide + formoterol | Yes | Same two drugs as Symbicort — the generic equivalent, much lower cost |
| Seretide | Fluticasone + salmeterol | No | Salmeterol is slow-onset, so it cannot double as a reliever |
| Seroflo | Fluticasone + salmeterol | No | Generic equivalent of Seretide |
| Budecort | Budesonide only | No | Steroid-only preventer — the budesonide half of Symbicort on its own |
In short: if you want a MART-capable inhaler, you need an ICS-formoterol combination — Symbicort or its generic. If you are on a fixed-dose fluticasone-salmeterol regimen and it controls you well, switching is rarely necessary. For a head-to-head on the fluticasone-salmeterol option, read our full Seretide inhaler guide.
Is There a Generic Version of Symbicort?
Yes — and this is where many people overpay needlessly. Budesonide and formoterol are both long-established, off-patent molecules, so the exact same combination is manufactured generically. The most widely available example we stock is Foracort (by Cipla), which contains budesonide + formoterol — the international brand of that combination is Symbicort. Other budesonide-formoterol generics exist in various markets under different names.
A generic is not a different or weaker medicine: it is the same actives at the same delivered doses, produced to WHO-GMP-certified manufacturing standards. The difference is price — generics typically cost a fraction of the originator brand for an identical clinical effect. Foracort comes in matching pMDI and dry-powder formats, so you can usually match whatever device you are used to.
Ordering Symbicort and Generic Budesonide/Formoterol
At MedsBase you can order both brand Symbicort Turbohaler and the generic budesonide/formoterol equivalent Foracort — no prescription needed, with the medicines sourced from WHO-GMP-certified manufacturers. Browse the full range in the asthma & COPD treatment category.
That said, asthma and COPD are serious conditions, and a combination inhaler is a controller — not something to start blind. If you have not been formally diagnosed, or your symptoms are changing or worsening, get assessed by a clinician first: the right strength, the right regimen (fixed-dose versus MART), and a written action plan all matter, and worsening breathlessness can be an emergency. Use this guide to understand your treatment, not to replace medical advice.
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Medical Disclaimer
This article is for general information only and is not a substitute for professional medical advice, diagnosis or treatment. Asthma and COPD can be life-threatening if poorly controlled. Always follow your own treatment plan and the product leaflet, do not change your dose or regimen without advice, and seek urgent medical help if your breathing worsens or a reliever stops working. Never use a long-acting bronchodilator without an inhaled steroid in asthma.
Frequently Asked Questions
What is Symbicort used for?
Symbicort is a daily preventer (controller) inhaler used to manage asthma and COPD. It combines an inhaled steroid (budesonide) to reduce airway inflammation with a long-acting bronchodilator (formoterol) to keep airways open. In a MART regimen it can also serve as your as-needed reliever.
Is Symbicort a steroid inhaler?
Partly. Symbicort contains a steroid — budesonide — together with the bronchodilator formoterol. So it is both a steroid inhaler and a long-acting bronchodilator in one device. The steroid is what prevents attacks over time, which is why it is taken every day.
Can I use Symbicort as a rescue inhaler?
Only within a specifically prescribed SMART/MART plan, and only with the lower strengths (100/6 or 200/6). This is possible because formoterol works within minutes. If you have been prescribed a separate blue salbutamol reliever instead, keep using that for rescue and do not improvise a MART regimen on your own.
How long does Symbicort take to work?
The formoterol opens your airways within a few minutes, so you may feel easier breathing quickly. The budesonide works gradually — its full anti-inflammatory benefit builds over one to two weeks of consistent daily use, which is why you must keep taking it even when you feel well.
Is there a generic version of Symbicort?
Yes. Budesonide and formoterol are off-patent, so the identical combination is sold generically — for example, Foracort by Cipla, made to WHO-GMP-certified standards. It contains the same actives at the same doses as Symbicort, typically at a much lower price.
What is the difference between Symbicort and Seretide?
Both are combination preventer inhalers, but the drugs differ. Symbicort is budesonide + formoterol; Seretide is fluticasone + salmeterol. The key practical difference is that Symbicort’s formoterol is fast-acting, so Symbicort can be used in a MART regimen, whereas Seretide cannot.
Why do I have to rinse my mouth after using Symbicort?
Inhaled steroid that settles in the mouth and throat can cause oral thrush and a hoarse voice. Rinsing with water and spitting it out after every dose washes that residue away and prevents both problems. Using a spacer with the aerosol version helps too.
Can I stop Symbicort once I feel better?
No — feeling well usually means the medicine is working, not that the condition has gone. Stopping abruptly can let inflammation and symptoms return. If your asthma is well controlled, your clinician may step you down to a lower dose or a steroid-only inhaler, but that should be a planned, supervised change.
Does Symbicort cause weight gain?
Inhaled budesonide is delivered in tiny doses straight to the airways, so it does not cause the weight gain associated with steroid tablets. Significant systemic steroid effects are uncommon with normal inhaled doses; they become more relevant only with prolonged high-dose use.
Written by
Sophie ChenPharmaceutical Content Researcher · 8 years experience
Sophie Chen is a pharmaceutical content researcher with 8 years covering generic medication access and clinical pharmacology. She specialises in international regulatory frameworks, bioequivalence standards, and patient-facing education on therapeutic drug classes. She is not a clinician.