Symbicort is a long-acting inhaler used to treat people with chronic airway problems, including asthma and COPD. A recent study has suggested that COPD patients who begin treatment with medications like Symbicort face a heightened risk of cardiovascular problems within the first 30 days of treatment.

What is Symbicort?

Symbicort belongs to a class of bronchodilators called inhaled long-acting β2-agonists (LABAs). The medication is currently approved for:

  • Maintenance treatment of asthma in patients 12 years or older whose asthma is severe or not well-controlled with other long-acting asthma medications.
  • Maintenance treatment of airflow obstruction in patients with COPD, including chronic bronchitis and emphysema.
  • Maintenance treatment of asthma in pediatric patients aged 6 to 12 years.
  • Reducing exacerbations of COPD.

Symbicort is a maintenance inhaler that is intended to be used daily (2 puffs per day, twice a day). Symbicort should never be used to treat an asthma attack that has already begun, as it will not work fast enough. Asthma attacks should only be treated with fast-acting rescue inhalers.

How Does Symbicort Work?

Symbicort contains two active ingredients, budesonide (an inhaled corticosteroid) and formoterol fumarate dihydrate (a LABA). Budesonide helps to reduce the amount of swelling in the airways, allowing more air to pass through the lungs.

LABAs like formoterol work by relaxing the muscles that surround the airways, thus helping to prevent bronchospasms.

Symbicort Side Effects

The most common Symbicort side effects include:

  • White patches in mouth or throat
  • Throat irritation after use
  • Stomach discomfort, vomiting
  • Cold symptoms (stuffy or runny nose, sneezing, sinus pain, sore throat, etc.)
  • Flu symptoms (fever, chills, body aches)
  • Back pain
  • Headache

Patients taking Symbicort should call their doctor if they experience:

  • Worsening asthma symptoms.
  • Breathing problems, such as wheezing or choking, following use.
  • White patches on the mouth or throat.
  • Vision problems, including blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights.
  • Symptoms of an infection, such as fever, chills, body aches, nausea, vomiting, or unusual tiredness.
  • Pneumonia symptoms, such as fever, cough with yellow or green mucus, stabbing chest pain, wheezing, feeling short of breath.
  • Signs that suggest swelling of the blood vessels, including numbness or tingling in the arms or legs, flu symptoms, stuffy nose, sinus pain, or skin rash.
  • Symptoms of low potassium, such as confusion, uneven heart rate, extreme thirst, increased urination, leg discomfort, muscle weakness or limp feeling.
  • Signs of high blood sugar, including increased thirst, increased urination, hunger, dry mouth, fruity breath odor, drowsiness, dry skin, blurred vision, weight loss.

Symbicort and Heart Problems

A study published in the January 2018 issue of JAMA Internal Medicine suggested that COPD patients who initiate new treatment with Symbicort and other long-acting asthma inhalers may be at a heightened risk for serious heart problems during the first 30 days of treatment.

The study, which was conducted by a team of researchers in Taiwan, involved more than 280,000 COPD patients who were prescribed either an LABA, like Symbicort, or a long-acting antimuscarinic antagonists (LAMA) from 2007 to 2011. The study authors reviewed their medical records in order to compare hospital visits for coronary artery disease, heart failure, ischemic stroke or arrhythmia against the duration since initiation of long-acting inhaler therapy.

The analysis indicated that patients who used either type of long-acting inhaler were 50% more likely to experience cardiovascular problems like a heart attack or stroke within the first 30 days of initiating treatment.

While the risk declined over time, the researchers suggested that doctors screen COPD patients for heart problems prior to initiating treatment with a long-acting inhaler. Patients who begin new treatment with a LABA or LAMA should seek medical attention for symptoms that might indicate a heart problem, such as chest pains or a suddenly rapid heart beat.

Patients should also undergo a follow-up exam after treatment has begun to ensure they’re not experiencing symptoms associated with cardiovascular disease, the study authors said.

  1. FDA (2017) “Highlights of Prescribing Information”
  2. JAMA Internal Medicine (January 2, 2018) “Association of Cardiovascular Risk With Inhaled Long-Acting Bronchodilators in Patients With Chronic Obstructive Pulmonary DiseaseA Nested Case-Control Study”
  3. Reuters (January 2018) “Starting New COPD Inhaler Tied to Heart Attack Risk”
Last Modified: January 11, 2018

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