Symbicort vs. Pulmicort

See how Symbicort and Pulmicort compare on approved uses, dosing, side effects, and cost.

Key Takeaways

  • Symbicort pairs an inhaled corticosteroid with a long-acting bronchodilator, while Pulmicort contains only the corticosteroid budesonide.

  • Symbicort is approved for both asthma and COPD, but Pulmicort's FDA approval covers asthma maintenance only.

  • Neither drug relieves sudden asthma or COPD symptoms, since both are meant for daily, long-term control.

Symbicort vs. Pulmicort Drug Summary

Symbicort

Symbicort combines an inhaled corticosteroid with a long-acting beta2-agonist for maintenance treatment of asthma in people 6 and older and for COPD. It's inhaled twice daily from a metered-dose inhaler, using either the 80/4.5 mcg or 160/4.5 mcg strength depending on disease severity.

Pulmicort

Pulmicort is an inhaled corticosteroid used alone for maintenance treatment of asthma in people 6 and older. It's inhaled twice daily as a dry powder, with doses ranging from 180 mcg up to 720 mcg depending on how severe the asthma is.

Symbicort vs. Pulmicort Side Effects

Symbicort

Most common
Nasopharyngitis (≥3%)
Upper respiratory tract infection (≥3%)
Headache (≥3%)
Pharyngolaryngeal pain (≥3%)

Pulmicort

Most common
Nasopharyngitis (up to 9.3%)
Nasal congestion (up to 2.7%)
Pharyngitis (up to 2.7%)
Viral upper respiratory tract infection (up to 2.2%)

Symbicort vs. Pulmicort Dosage

Symbicort

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 2 inh 80/4.5 mcg twice daily At the start
Maximum dose 2 inh 160/4.5 mcg twice daily If needed
Dose changes 1 increase As tolerated

Pulmicort

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 180 mcg twice daily At the start
Maximum dose 720 mcg twice daily If needed
Dose changes 2 increases As tolerated

Symbicort vs. Pulmicort Indications

Symbicort

Symbicort is FDA-approved for maintenance treatment of asthma in patients 6 years and older and for maintenance treatment of COPD, including chronic bronchitis and emphysema. It also helps reduce COPD exacerbations. It is not intended for relief of sudden asthma or COPD symptoms.

  • Maintenance treatment of asthma, ages 6+

  • Maintenance treatment of COPD (bronchitis, emphysema)

  • Reduces COPD exacerbations

  • Not for relief of sudden asthma or COPD symptoms

Pulmicort

Pulmicort is FDA-approved only for maintenance treatment of asthma in patients 6 years and older, used as preventive therapy rather than rescue treatment. It is sometimes used off-label to manage eosinophilic esophagitis. It is not approved for COPD or for relieving acute breathing symptoms.

  • Maintenance treatment of asthma, ages 6+

  • Off-label use for eosinophilic esophagitis

  • Not approved for COPD

  • Not for relief of sudden asthma symptoms

Symbicort vs. Pulmicort Pros and Cons

Symbicort

Symbicort adds a long-acting bronchodilator to an inhaled steroid, which can improve breathing control beyond a steroid alone. It carries a boxed warning about the LABA component's link to asthma-related death, and it is not used for quick symptom relief. It is also the only one of this pair approved for COPD.

Pros

  • Combines corticosteroid and bronchodilator in one inhaler

  • Approved for both asthma and COPD

  • Pediatric approval down to age 6 for asthma

  • Higher strength option for more severe COPD

Cons

  • Boxed warning for LABA-related asthma death risk

  • Not usable for acute asthma or COPD symptoms

  • Requires coordinated inhaler technique (MDI)

  • Two active ingredients raise side effect potential

Pulmicort

Pulmicort delivers only an inhaled corticosteroid, so it avoids the LABA boxed warning that comes with combination inhalers. It is approved solely for asthma, not COPD, and some patients may still need a separate bronchodilator for added control. It also comes in a nebulized form for children too young for a dry powder inhaler.

Pros

  • No LABA boxed warning since it's steroid-only

  • Available as Respules for children under 6

  • Simpler single-ingredient corticosteroid dosing

  • Dry powder inhaler needs less hand-breath coordination

Cons

  • Not approved for COPD treatment

  • Contains trace milk protein, risk for severe allergy

  • May need added bronchodilator for asthma control

  • Off-label uses lack FDA approval and evidence base

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