There are multiple treatment options for asthma — including inhaled and oral medications — that can be prescribed based on the severity of your condition.

As part of your asthma action plan, a doctor may recommend an inhaled corticosteroid treatment, such as Symbicort. This is also sometimes called “SMART” therapy when the medication is used to help control and relieve asthma symptoms.

Read on to learn more about SMART therapy for asthma, including the potential benefits and possible risks of using Symbicort.

SMART therapy refers to an asthma treatment approach known as single-maintenance and reliever therapy or Symbicort maintenance and reliever therapy.

Symbicort is a type of inhaled long-term controller asthma medication. It combines two active ingredients in one inhaler: a corticosteroid called budesonide and a bronchodilator called formoterol.

Inhaled corticosteroids work by decreasing airway inflammation and are taken regularly to help prevent asthma flare-ups before they start.

Bronchodilators help relax airways so you can breathe easier. Formoterol is a long-acting beta-agonist (LABA) bronchodilator, which provides long-term asthma control rather than quick symptom relief.

However, the idea behind SMART therapy is that Symbicort may act as both the controller and reliever inhaler to reduce overall asthma symptoms. Research also suggests that formoterol in Symbicort may provide quicker relief than certain SABA inhalers.

What is the difference between Ventolin and Symbicort?

Ventolin is a brand name for albuterol sulfate, a type of short-acting beta-agonist (SABA). While both Ventolin and Symbicort are inhaled medications, their purposes are quite different.

Ventolin is considered a rescue inhaler that may be used every 4 to 6 hours which works to open up the airways and control asthma symptoms. On the other hand, Symbicort is intended for daily, long-term use to decrease airway inflammation and constriction.

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If you have asthma and are relying on a rescue inhaler more than twice a week, this could indicate that your condition is not being well-controlled with your current treatment plan. At this point, you may qualify for long-term medications such as SMART therapy.

With continued use as prescribed, you may experience decreased:

  • airway swelling
  • bronchoconstriction
  • mucus production
  • airway hypersensitivity

The involvement of an inhaled corticosteroid is another benefit of SMART therapy. Unlike oral steroids, inhaled versions directly target the airways, thereby involving fewer side effects. Some research also suggests that SMART therapy may be more cost-effective.

However, not everyone is a candidate for SMART therapy, including those who already use LABAs for asthma treatment. SMART therapy is also intended to reduce the need for SABAs, but some people may still need rescue medications for flare-ups.

SMART therapy is primarily intended for people with moderate or severe persistent asthma, who are also 12 years or older. To date, research has only confirmed the safety and efficacy of Symbicort as part of SMART therapy, with other inhaled corticosteroid/LABA combinations yet to be clinically studied.

Symbicort is typically prescribed as a maintenance treatment, and users take two puffs of the inhaler twice a day. It’s available in either 80 microgram (mcg) budesonide/4.5 mcg formoterol or 160/4.5 doses and may be prescribed for people with asthma who are 6 years of age or older.

One study of SMART therapy in adults with moderate to severe asthma suggests that medium doses were more effective than low doses at preventing flare-ups. Participants also used SABAs as needed for asthma exacerbations.

Remember that everyone’s body is different, and these guidelines are just that: general guidelines. Always follow the dosage instructions your doctor prescribes with your asthma medications carefully.

They may advise that you proceed differently based on your asthma symptoms and any other health factors that might influence your asthma treatment.

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Symbicort itself doesn’t make asthma worse. However, research shows that there’s a higher chance of asthma-related hospitalization and death in people who use formoterol as a monotherapy, or without using an inhaled corticosteroid alongside it.

Also, if you experience worsening wheezing or other asthma symptoms, this could mean that the medication isn’t working as it should. Call a doctor if your asthma gets worse and/or if you’re frequently relying on a rescue inhaler.

Additionally, before starting Symbicort, there are short-term side effects and long-term risks to consider.

What are the common side effects of Symbicort?

Make sure to discuss any new side effects with a doctor. The most common side effects of Symbicort asthma treatment include:

What are the long-term side effects of Symbicort?

Aside from short-term side effects, there are also long-term risks you should discuss with a doctor before using immunosuppressing medications like Symbicort. AstraZeneca, the company that makes Symbicort, outlines the following possibilities:

Some of the serious side effects associated with Symbicort may be a result of using the medication with another LABA or from excessive use (more than two puffs every 12 hours).

The answer to this question isn’t simple, as opting for an alternative to Symbicort could ultimately mean taking more than one medication separately.

SMART therapy is intended to reduce your need for multiple types of asthma medications. In theory, this might help decrease the overall costs of your asthma treatment.

Still, the out-of-pocket cost for a 30-day supply of Symbicort 80/4.5 and 160/4.5 is about $303 and $347, respectively. The exact amount you may have to pay depends on your overall insurance coverage as well as what your pharmacy charges for the medication.

As of 2022, the cost of Symbicort with Medicare Part D was $31 per month. Medicaid also significantly offsets the cost of Symbicort, with some people paying as little as $2 per month.

If you’re having trouble affording Symbicort, talk with a doctor. They may refer you to assistance programs or offer coupons to make your medication more affordable. You can also ask your doctor to prescribe a generic version to reduce the overall cost.

Alternatives to Symbicort ultimately depend on the severity of your asthma, how well it’s being managed, and how you have responded to other medications in the past.

One option is to start with an inhaled corticosteroid only before using a LABA-combination medication like Symbicort. Keep in mind that it is not safe to take a LABA without an inhaled corticosteroid.

Other asthma treatment options include:

Living with asthma

Aside from medical support from a doctor, it’s important to connect with other resources that support your overall well-being when living with asthma.

Consider starting with local support groups from the Asthma and Allergy Foundation of America or virtual groups from the Better Breathers Network.

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SMART therapy is an asthma treatment approach that involves the use of Symbicort. This is an inhaled medication taken daily that combines both a corticosteroid and a LABA to help reduce inflammation and airway constriction.

While some people may still need to use a SABA, or rescue inhaler, for occasional flare-ups, the idea behind SMART therapy is to reduce the reliance on multiple asthma medications.

If you’re currently experiencing moderate or severe uncontrolled asthma, talk with a doctor about your treatment options. They may recommend SMART therapy as a long-term solution.