Is Symbicort A Rescue Inhaler?

Back in 2010, I wrote about the Symbicort SMART program, a groundbreaking approach approved in Europe that allowed Symbicort to be used both as a controller and rescue inhaler. The program permitted asthmatics to use it up to eight times per day, providing a flexible and effective way to manage symptoms. Not only was the program highly successful, but it was also proven to be safe.

Despite the enthusiasm in Europe for using Symbicort as a rescue inhaler, the U.S. FDA remained cautious, maintaining that "Symbicort should not be used for the relief of acute symptoms, i.e., as rescue therapy for the treatment of acute episodes of bronchospasm." (1)

This caution stemmed from outdated data suggesting that long-acting beta-agonists (LABAs), when used more than twice daily, were associated with an increased risk of asthma-related deaths.

I found this frustrating, especially knowing the success of the Symbicort SMART program and having personally used Symbicort as a rescue inhaler with good results—though I did this against my doctor's advice. Unfortunately, my insurance company would only allow one inhaler per month, based on outdated regulations. So, despite knowing how effective it was, I couldn’t use Symbicort in this way long-term due to antiquated insurance policies.

The idea behind using Symbicort as a rescue inhaler is that, during an asthma attack, you would benefit from both the fast-acting beta-agonist to open the airways and the inhaled steroid to reduce inflammation. This combination works better than a beta-agonist alone in both reversing and controlling symptoms -- according to studies. 

Thankfully, in 2017, the FDA finally approved Symbicort for use as a rescue inhaler. However, it took several more years for this information to be widely shared within the medical community. Even to this day, in the U.S., you rarely see physicians prescribe Symbicort as a rescue inhaler(2)

The FDA tends to move slowly when approving treatments that have already proven helpful in other parts of the world. Still, this was a positive development. A doctor friend of mine (a hospitalist) even said, "Don't be surprised if I start ordering Symbicort as a rescue inhaler." I found this impressive, as many doctors still don’t realize that Symbicort can open airways just as quickly as Albuterol.

One reason Symbicort may be superior to Albuterol is that, when you're experiencing asthma symptoms, you also get the added benefit of the steroid to control inflammation. Along with my doctor friend who mentioned he might start prescribing Symbicort as a rescue inhaler, my son's doctor echoed this advice. She told my son that, when experiencing asthma symptoms, he should use his Symbicort inhaler rather than Albuterol.

Since the FDA’s approval of Symbicort as a rescue inhaler, the makers of Albuterol have responded by developing an inhaler that combines Albuterol with an inhaled steroid. That inhaler is called AirDuo RespiClick, and it will be the topic of an upcoming post—so stay tuned!

References.

1. Package Insert for Symbicort prior to 2017, https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/021929s013lbl.pdf, accessed 9/9/202
2. 1. "US FDA approves Symbicort (budesonide/formoterol) for the treatment of asthma in paediatric patients," Astrazeneca.com, 2017, January 30, https://www.astrazeneca.com/media-centre/medical-releases/US-FDA-approves-Symbicort-budesonide-formoterol-for-the-treatment-of-asthma-in-paediatric-patients-300120170.html#, accessed 9/9/2024