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
Pulmicort
Symbicort vs. Pulmicort Dosage
Symbicort
Pulmicort
| 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 |
| 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
| 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
| 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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