Two medicines in every dose
Someone with asthma who only uses a bronchodilator can feel fine for a day and still have airways that stay swollen underneath. Here every product combines formoterol with budesonide so both problems are treated at once. Formoterol (some packs say formoterol fumarate dihydrate) relaxes the muscle ring around the airways for roughly 12 hours. Budesonide is an inhaled steroid that reduces the inflammation, in asthma and in COPD (chronic obstructive pulmonary disease, long-term lung damage that leaves you breathless). The routine is morning and evening, every day. An attack that comes on suddenly is a job for a fast-acting reliever.
Choosing between the inhaler, the rotacaps and Symbicort Powder
Which device suits you is largely a matter of what feels easy in your hand. Budesonide Formoterol Inhaler is a pressurised canister: a quick shake, a full breath out, then a slow breath in through the mouthpiece while you press the top. Budesonide Formoterol Rotacaps are capsules made for a dry-powder device — they are not swallowed; each one is loaded, pierced inside the inhaler and breathed in as powder. Symbicort Powder is a dry-powder inhaler sold in a single strength, 160/4.5mcg. The numbers on a pack give budesonide first and formoterol second: the inhaler spans 100/6mcg, 160/4.5mcg, 200/6mcg and 400/6mcg, while the rotacaps run to 100/6mcg, 200/6mcg and 400/6mcg. A bigger first number means more steroid in each puff or capsule. Rinse the mouth and spit the water out after a dose; that cuts the chance of a hoarse voice and of the white patches an inhaled steroid can leave in the mouth. Capsules stay in the blister strip until you are ready to load one. All three sit in the asthma and respiratory range.
What people notice, and what is urgent
Headache, shaky hands, a pounding or faster heartbeat, a sore throat, a hoarse voice and a dry mouth are the ones people report most, and many find they ease with time. Muscle cramp and restlessness are reported too. Some effects are urgent: a rash or hives with swelling of the face, lips, tongue or throat; breathing that tightens rather than eases just after a dose; and a racing or irregular heartbeat or chest pain that will not settle.
Other medicines that get in the way
Beta-blockers, taken for blood pressure or a heart condition, push the other way and can weaken formoterol's effect on the airways. Some antidepressants and diuretics (water tablets) also change how the body handles it.