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Budesonide and Formoterol Inhalers for Asthma Management

Changes in the airways during an asthma attack

Changes in the airways during an asthma attack

What Are Budesonide and Formoterol?

Budesonide and formoterol are medications that are frequently prescribed for asthmatics. They're generally used in an inhaled form to prevent an asthma attack from occurring. Budesonide is a corticosteroid that reduces inflammation in the airways. Formoterol causes bronchodilation, or widening of the airways. The medications may be sold in separate inhalers or may be combined in the same one.

A popular product that contains both medications is Symbicort. This inhaler is used daily, even when an asthmatic is healthy. I use a Symbicort inhaler to manage my asthma. It has some disadvantages. It’s an expensive medication. In addition, I don’t like taking medications on a daily basis. I find that Symbicort is very effective when I use it regularly, however. If I stop using it, my asthma soon returns.

A combination of budesonide and formoterol is helpful for me and for many other people, but it may not be appropriate for you if you're an asthmatic. I’m a science writer and an experienced biology teacher, but I'm not a medical practitioner. Make sure that you see your doctor if you want to use either or both of the medications. They may have side effects, which can occasionally be serious. In addition, they shouldn't be used in combination with specific medicines and should be avoided if you have certain medical conditions.

Symbicort is the name of an inhaler and a budesonide and formoterol powder. This photo shows the cap of the inhaler and the canister containing the powder.

Symbicort is the name of an inhaler and a budesonide and formoterol powder. This photo shows the cap of the inhaler and the canister containing the powder.

An Important Note

Anyone with questions about asthma management or about the effects of the medications mentioned in the article should consult a doctor. They should also contact the doctor if prescribed medications stop working. Recent research has revealed that not all patients respond to the same asthma medicines identically.

What Is Asthma?

The airways are the tubes that transport inhaled air into and through the lungs so that oxygen can be absorbed into the bloodstream. They also transport exhaled air out of the lungs to the outside world. This exhaled air contains carbon dioxide waste picked up from the blood.

During an asthma attack, the muscles around the airways tighten, and the airways constrict. This makes it very hard for a person to inhale enough air. In addition, the linings of the airways become inflamed and swollen and there is an increased production of mucus. The mucus may block the airways.

Common symptoms of an asthma attack include:

  • difficulty breathing
  • chest tightness
  • a wheezing or whistling sound as the person tries to breathe
  • coughing as the person attempts to clear the airways of mucus

Asthma medications can be very effective. The disorder has the potential to be an emergency or even a deadly condition, however. This is why an asthma management plan is so important. If a plan no longer controls the symptoms, a new plan needs to be established with the help of a doctor.

The Symbicort label is in English and French because Canada (where I live) is officially a bilingual country.

The Symbicort label is in English and French because Canada (where I live) is officially a bilingual country.

Causes of Asthma

Although the triggers for asthma attacks are known, the reason why an asthmatic's body responds inappropriately to a trigger isn't clear. There seems to be a genetic component to asthma, since the disorder often runs in families.

Common triggers for asthma attacks include allergens such as house dust or pollen, smoke or pollution in inhaled air, physical stress caused by exercise, the inhalation of cold air, or the presence of a viral infection such as a cold or the flu.

Asthma can't be cured, but asthma attacks can be treated. They can often be prevented as well. Asthmatics need to discover their own particular triggers and find ways to weaken or prevent asthma attacks. A doctor's advice is vital.

Asthma is becoming increasingly common in some parts of the world, including North America. The reason for this trend is unknown, although there are several theories that attempt to explain the observation. A better understanding of the causes of asthma may lead to improved treatments and prevention strategies.

Medications for the Disorder

Asthma medications are often designed to be inhaled. The inhalers fall into two general categories —rescue inhalers that are used during an asthma attack and maintenance inhalers that are used between attacks.

Medications for asthma and other disorders have three names.

  • The chemical name follows the international rules for naming chemical compounds and may be complex.
  • The generic name is given to the chemical when it's supplied to the pharmaceutical industry.
  • The brand name is given to the chemical by the drug company that sells the substance.

Although most asthma medications are inhaled, oral medications may also be prescribed to prevent asthma attacks.

Rescue or Reliever Inhalers

Most asthma medications are inhaled so that the medicine goes straight to the lungs. Albuterol, also known as salbutamol, is the generic name of a common medication used in rescue or reliever inhalers. These are used to relieve symptoms during an asthma attack. A frequently prescribed brand of albuterol is Ventolin.

Rescue inhalers are often blue. Unfortunately, the colour coding for asthma inhalers is not universal, which may be confusing for patients. An asthma attack may appear suddenly. If a person is unable to read medication labels clearly, it's very helpful for them to know that the blue inhaler will relieve their symptoms.

Most rescue asthma medications are delivered in a metered dose inhaler. This is a device that delivers a controlled amount of medication when the canister is depressed. The medication is delivered in the form of an aerosol. The method for using a metered dose inhaler is shown in the video below.

Maintenance, Preventer, or Controller Inhalers

Maintenance inhalers are used according to a regular schedule in order to reduce or prevent asthma attacks. They maintain the health of the airways and prevent them from responding abnormally to a stimulus.

Budesonide is the generic name of a corticosteroid that is used in maintenance or preventer inhalers. One brand name of budesonide that is often used is Pulmicort. Fluticasone is the generic name of another inhaled corticosteroid used to prevent asthma. Flovent is a brand of fluticasone. Advair contains both fluticasone and salmeterol, which is a bronchodilator.

Maintenance inhalers have a colour other than blue. The medication is often delivered by a device known as a turbuhaler. The use of a Symbicort turbuhaler is demonstrated in the video below.

Another Inhaler Category

Formoterol falls into a third category of asthma medications. It has some ability to act as a rescue medicine and also acts as a maintenance medicine. Foradil is a common brand of formoterol.

Untreated asthma can cause changes in the airways. In this picture, the lumen (cavity) inside a bronchiole has become obstructed. The bronchioles are important airways.

Untreated asthma can cause changes in the airways. In this picture, the lumen (cavity) inside a bronchiole has become obstructed. The bronchioles are important airways.

Budesonide Benefits

Budesonide is the generic name of an artificial corticosteroid. It's prescribed for long-term use to prevent asthma flare-ups and the repeated use of rescue inhalers. When inhaled regularly, the medication reduces inflammation and hyperactivity in the air passages. Inhaled budesonide exerts its main effect on the lungs. Only a small amount is absorbed into the body.

Possible Side Effects of Budesonide Use

It's important that a patient discusses potential side effects of any medication— including budesonide and formoterol—with their doctor. Reading the pamphlet that accompanies the medication is also important.

Inhaled budesonide may encourage the development of an oral infection called thrush. This infection is caused by a fungus and appears as white spots in the mouth and throat. Rinsing the mouth out thoroughly after using the inhaler can prevent the infection from happening. (This works for me.) Other side effects may be a sore throat and a hoarse voice.

More serious side effects of budesonide use are less likely. If large doses of the inhaled medication are taken for a long time, however, some of the side effects caused by oral corticosteroids may develop. These include:

  • thinning of bones
  • slow growth in children
  • cataracts
  • glaucoma
  • inhibition of natural corticosteroid production by the adrenal glands

Rarely, a person may be allergic to budesonide, may experience breathing difficulties after using the medication, or may experience problems such as nervousness, depression, or behavioral changes.

Pay Attention to Side Effects

The only side effect of asthma medication use that I've experienced is a rapid heartbeat caused by taking my rescue inhaler (Ventolin) too often. Now that symbicort is keeping my asthma under control, I don't experience any side effects. Other people may have different experiences, however. Problems caused by inhaler use should be mentioned to a doctor.

Formoterol Benefits

Formoterol is a bronchodilator, which means that it widens the airways, or the bronchi and the bronchioles. Formoterol belongs to a class of medications known as beta-agonists. A beta-agonist binds to beta receptors, including those found on the cell membranes of muscle cells around the airways. When beta-agonists bind to the beta receptors they cause the muscles to relax, widening the airways.

There are two kinds of beta-agonists. Short-acting types (such as albuterol) begin to work within a few minutes and continue to work for four to six hours. They're used in rescue or reliever inhalers. Formoterol is a long-acting beta agonist. It starts working quickly and keeps working for about twelve hours. It's inhaled on a schedule—usually in the morning and in the evening—to prevent asthma attacks.

The coloured patch on the upper right of the Symbicort canister starts out white when the inhaler is full. The red flag gradually appears as the inhaler approaches the empty point.

The coloured patch on the upper right of the Symbicort canister starts out white when the inhaler is full. The red flag gradually appears as the inhaler approaches the empty point.

Using a Symbicort Turbuhaler

Symbicort is delivered to the airways in the form of a very fine power. To send a dose of powder into the delivery area, the red wheel at the base of the turbuhaler must be turned as far as it can in one direction and then as far as it can in the other direction. A click will be heard during this procedure.

Possible Side Effects of Formoterol Use

It's often recommended that formoterol isn't used as the only asthma medication because in a few cases a related long-acting beta-agonist has been found to make asthma attacks worse instead of better. It's unknown if formoterol has the same effect, but the possibility exists. According to what I've read, the current recommendations are that a formoterol inhalation should be accompanied by an inhaled corticosteroid, such as budesonide, and the rescue inhaler shouldn't contain formoterol. Information about this topic can be read on the U.S. National Library of Medicine site referenced below.

Formoterol has a range of possible side effects. As is the case for budesonide use and the use of many other medications, not everyone will experience side effects, but some people will. The effects will generally be minor, but major problems may develop. Relatively minor problems include:

  • a headache
  • dizziness
  • nausea
  • stomach pain
  • muscle pain
  • sore throat
  • dry mouth
  • shakiness
  • tiredness
  • insomnia

More serious side effects include a rapid and irregular heartbeat, a rash, and swelling of the face, throat, or extremities. If side effects continue or are severe, a doctor should be consulted.

Value of a Peak Flow Meter

A peak flow meter measures how fast air leaves the lungs. This information can be a valuable component of an asthma management plan. It indicates whether or not someone is keeping their airways clear. Someone with a severe problem would know about it without a test, but some people with a milder problem may be used to the situation and may not realize that the problem exists.

Preventing an Asthma Attack

The ideal situation for an asthmatic is to avoid personal triggers and to use as little medication as possible. However, if the asthma is proving hard to control, a higher level of medication may be needed.

Rescue inhalers shouldn't be used frequently. If they're used too often they can cause additional health problems, such as a rapid heartbeat. Frequent use of a rescue inhaler indicates that asthma is out of control.

If you realize that you are losing control of your asthma, you need to talk to your doctor to come up with a new treatment plan that is both safe and effective. When asthma is properly managed, a person with the disorder should be able to live a normal life. There may one day be a cure for asthma, but until that time its management is very important.


This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.

© 2012 Linda Crampton


Linda Crampton (author) from British Columbia, Canada on June 24, 2012:

Thank you for the comment and the vote, teaches. I appreciate them both! Yes, it is very important for asthmatics to avoid their personal triggers if they can. It's so much better to prevent an asthma attack then to have to treat it.

Dianna Mendez on June 24, 2012:

I have family members who have to deal with asthma. Your hub is very well written and researched and provides a good deal of helpful advice on how to deal with the treatments. I am glad that you posted the triggers are what one needs to avoid and to keep meds to a minimum. Voted up.

Linda Crampton (author) from British Columbia, Canada on June 24, 2012:

Hi, Nell. It's interesting to discover how common asthma is. I do sympathize with you and anyone else who had asthma as a child. I know that when she was growing up my sister had a very difficult time with the disorder. It's hard for a child to deal with asthma, although the situation is getting better now as new medicines are created and new discoveries are made about the disorder.

Nell Rose from England on June 24, 2012:

Hi Alicia, I know these medicines very well. I am an asthmatic, have been since I was a child and yes it definitely runs in families. My uncle got it badly and now my brother does too. Great information and voted up! cheers nell

Linda Crampton (author) from British Columbia, Canada on June 24, 2012:

Hi, Tina. Thank you very much for the comment and the votes! It must have been very hard experiencing asthma as a child. I agree with you, the prevention medicines that are available today are wonderful!

Christina Lornemark from Sweden on June 24, 2012:

This hub is packed with information and you have done a great job Alicia! I also have asthma and I use the combination treatments, it is very helpful and I can live an almost normal life. I have had asthma since I was a child so I know how difficult it was before, when these medications didn't exist as a daily prevention medication. Voted up, useful, interesting


Linda Crampton (author) from British Columbia, Canada on June 23, 2012:

Thank you for the visit and the kind comment, drbj. Asthma is an interesting topic to write about. It's an increasingly common disorder, too, which is not good!

drbj and sherry from south Florida on June 23, 2012:

This is a very thorough and extensive examination of asthma and appropriate medications, Alicia. But then I have come to expect nothing less from you. Voted up, m'dear.

Linda Crampton (author) from British Columbia, Canada on June 23, 2012:

Thank you so much for the lovely comment, Peggy!! I appreciate it very much, as well as the votes and the tweet. There definitely seems to be a genetic component to asthma in my family - my sister and father are also asthmatics, although my mother wasn't. At least I didn't develop asthma until I was an adult. My sister's had to deal with the disorder since childhood.

Peggy Woods from Houston, Texas on June 23, 2012:

So sorry to hear that you have to deal with handling asthma but knowing how smart you are, you have probably figured out all of the triggers and are managing it beautifully. This is an excellent hub loaded with good information as I have come to expect from your writing. Voted up, interesting and useful. Tweeting. Thanks!