Symbicort vs Albuterol

June 10, 2025/Andrew Le

Symbicort helps control asthma every day by reducing swelling and relaxing airway muscles. This keeps your breathing steady. On the other hand, albuterol jumps in fast when you suddenly can’t breathe well, opening the airways quickly to help you recover.

But wait — when should you use each one? And how do they really work inside your body?

🔑 Key Takeaways

➤ Symbicort is taken twice a day to keep lung swelling down and make breathing easier.

➤ Albuterol is used only when you suddenly have trouble breathing because it opens airways fast.

➤ Symbicort combines one medicine that calms swelling and another that relaxes airway muscles.

➤ Albuterol works within minutes but does not help control asthma over the long term.

➤ Using Symbicort every day can cut down on how often you need your rescue inhaler.

➤ Common Symbicort side effects include sore throat, mouth infections, and sometimes higher blood sugar.

➤ Common albuterol side effects include shakiness, a fast heartbeat, and headaches.

Mechanism of Action

Symbicort helps control asthma every day and prevent attacks with two medicines (one for swelling, one for muscle relaxation), while albuterol works quickly to open airways during sudden breathing problems but is not for daily use.

Symbicort’s Mechanism of Action

Symbicort works through a two-part mechanism:

  1. The first part involves budesonide, a corticosteroid. Budesonide reduces inflammation inside the lungs, helping to calm swelling and irritation in the airways. 
  1. The second part uses formoterol, a long-acting bronchodilator. Formoterol works by relaxing the smooth muscles that surround the airways, making it easier for you to breathe. 

Together, these two medications help control asthma and chronic obstructive pulmonary disease (COPD) symptoms. Interestingly, the combination is safe because, although formoterol alone can increase the risk of death in asthma patients, this risk is not seen when it is combined with budesonide. 

In fact, the National Institutes of Health guidelines even support using Symbicort as SMART Therapy (Single Maintenance And Reliever Therapy) for people with moderate to severe persistent asthma. This means you can use the same inhaler both as a daily maintenance medication and as a reliever when symptoms appear, though only up to a maximum of 8 to 12 puffs per day, depending on your age. 

This dual approach helps prevent attacks before they start, giving you more consistent control.

Albuterol’s Mechanism of Action

Albuterol works quite differently from Symbicort. Albuterol is a short-acting beta-agonist (SABA) that acts quickly on β2-adrenergic receptors in the bronchial smooth muscle. Once it binds to these receptors, it triggers the muscles to relax, opening up the airways fast. This action is crucial during sudden asthma attacks or episodes of bronchospasm because it provides rapid relief. Although albuterol does affect β1 receptors in the heart slightly, its primary focus is on the lungs. 

In a study using 1080 mcg of albuterol base, the drug reached peak blood concentrations of about 3 ng/mL, but it mainly acts locally in the lungs when inhaled. This makes it effective for acute situations without flooding the whole body. 

Unlike Symbicort, albuterol is not designed for daily maintenance or long-term control. It’s what you reach for when you need quick help — like during an exercise-induced bronchospasm or a sudden worsening of asthma symptoms.

Indications and Uses

Symbicort is used every day to control asthma or COPD and prevent flare-ups, while albuterol is used as a quick rescue medicine to relieve sudden asthma or COPD symptoms.

Symbicort Indications and Uses

Symbicort (budesonide/formoterol fumarate dihydrate) is used to treat asthma in patients who are 6 years and older when their asthma is not well-controlled with other long-term asthma medications, like inhaled corticosteroids (ICS). It can also be used if the doctor decides the patient needs both an ICS and a long-acting beta2-adrenergic agonist (LABA) from the start. 

Importantly, Symbicort 160/4.5 is also approved for adults with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema. It helps maintain airflow and reduces COPD flare-ups.

⚠️ Important Considerations

Note that Symbicort is not a rescue inhaler. According to AstraZeneca, it should not be used to treat sudden breathing problems or acute bronchospasm. That means if you or someone you care for is having a sudden asthma attack, Symbicort won’t help. Instead, fast-acting medications should be used in those situations. 

This is a common misunderstanding among patients. That’s why it’s crucial to follow your doctor’s instructions carefully when using Symbicort.

Albuterol Indications and Uses

According to the American Society of Health-System Pharmacists (ASHP), albuterol is prescribed to prevent and treat wheezing, shortness of breath, chest tightness, and coughing caused by lung diseases like asthma and COPD. It belongs to a group of medications called bronchodilators, and it works by relaxing the muscles around the airways so they open up and make breathing easier.

Here’s where it’s different from Symbicort: albuterol is used as a rescue medication. 

According to ASHP, albuterol quickly relieves acute symptoms during asthma attacks or COPD flare-ups. It comes in several forms, including tablets, syrup, and extended-release tablets, and patients are usually told to take it three or four times daily. Sometimes it’s even used before exercise to prevent exercise-induced asthma. 

But remember, albuterol helps manage symptoms — it doesn’t cure the condition.

Administration

Symbicort is taken twice daily for long-term control (sometimes with extra doses if a doctor allows), while albuterol is taken only as needed for fast relief of breathing problems.

Symbicort Administration

Symbicort is taken twice daily, two puffs each time, for long-term asthma or COPD control. The inhaler has a dose counter to track usage. Symbicort combines budesonide (anti-inflammatory) and formoterol (long-acting bronchodilator), providing both maintenance and, when instructed, rescue use.

Some patients use Symbicort under SMART (Single Maintenance and Reliever Therapy), meaning they take their regular doses plus extra puffs if symptoms appear. However, this off-label use must only happen if a doctor specifically advises it, as Symbicort is not FDA-approved as a rescue inhaler.

Symbicort’s half-life is about 7.9 hours, supporting its twice-daily schedule. Patients should not exceed prescribed doses unless under SMART guidance.

Albuterol Administration

According to Dr. David Beuther, the usual dose is two puffs every four to six hours, with a maximum of 12 puffs per day.

Albuterol works within minutes, lasting four to six hours. It has a half-life of about 6.5 hours. It comes in various forms, but the inhaler is the most common for asthma and COPD.

Frequent albuterol use signals poor disease control and patients should talk to their doctor if they rely on it often.

Efficacy

Symbicort gives steady asthma control and reduces the need for rescue inhalers, while albuterol works well for quick relief but is even more effective when combined with budesonide to prevent severe attacks.

Symbicort Efficacy in Asthma

According to a study, Symbicort was tested in patients who had asthma symptoms even though they were already using steroid inhalers. Over 12 weeks, the people who used Symbicort improved their morning lung strength by about 37 liters per minute. This was very similar to the results in people who used budesonide plus formoterol in separate inhalers (36 liters per minute). But when people used only budesonide, the improvement was much smaller — only about 5 liters per minute.

This means Symbicort and the budesonide + formoterol combination both helped patients breathe much better than using just a steroid inhaler alone.

Symbicort also helped patients go longer before they had a mild asthma worsening (called an exacerbation). This shows that Symbicort not only improved daily breathing but also helped protect against asthma attacks.

According to another study, Symbicort worked very fast. On the first day of treatment, nearly 80% of the breathing improvement happened within 15 minutes after using the inhaler. By the second week, that fast effect was still there, and by the end of the 12-week study, about 90% of the improvement still happened within the first 15 minutes.

So Symbicort provided quick relief — patients started to feel better very soon after using it — and this fast improvement kept working over time.

Albuterol Efficacy in Asthma

The MANDALA study looked at people with moderate to severe asthma and compared two rescue treatments: regular albuterol vs. albuterol combined with budesonide. Among adults whose asthma got worse with exercise, those using the albuterol + budesonide combo had 43% fewer severe asthma attacks compared to those using albuterol alone.

So adding budesonide to albuterol gave much stronger protection against serious asthma flare-ups.

Also, the study found that the people using albuterol + budesonide needed half as much oral steroid medicine over the year compared to those using albuterol alone. Oral steroids are usually used when asthma flares get really bad, but they can have serious side effects.

According to another study, albuterol delivered in two different ways was compared: one using a special dry powder inhaler (Spiros) and one using the regular metered-dose inhaler (MDI). Both types worked well and gave similar improvements in breathing.

So, it didn’t matter which device was used — both ways of giving albuterol were safe and helped patients breathe better compared to doing nothing (placebo).

Side Effects

Symbicort and albuterol can both cause side effects like headache and sore throat, but Symbicort may add risks like mouth yeast infections and high blood sugar, while albuterol more often causes shakiness, fast heartbeat, and anxiety.

Symbicort Side Effects

Symbicort can cause the following side effects:

  • Back pain
  • Flu
  • Headache
  • Nasal congestion
  • Stomach discomfort
  • Throat irritation or sore throat
  • Upper respiratory infection or sinusitis
  • Vomiting
  • Yeast infection in the mouth (thrush)
  • Jitteriness
  • Heart palpitations (milder and less common than with albuterol)
  • Sinus pain
  • Stuffy nose
  • Nausea
  • Blood potassium levels decreasing
  • Pneumonia
  • Blood vessel swelling
  • Osteoporosis
  • Hyperglycemia (high blood sugar)
  • Hypocortisolism (adrenal insufficiency)
  • Glaucoma or other eye problem
  • Oral fungal infections (mouth/throat)

Albuterol Side Effects

Albuterol can cause the following side effects: 

  • Fast, irregular, pounding, or racing heartbeat or pulse
  • Shakiness in the legs, arms, hands, or feet
  • Trembling or shaking of the hands or feet
  • Headache
  • Dizziness
  • Sore throat
  • Runny nose
  • Muscle aches
  • Trouble sleeping
  • Change in taste
  • Dry mouth
  • Anxiety
  • Shortness of breath
  • Cramps
  • Bad taste
  • Rapid heart rate (tachycardia)
  • Sense of fluttering or pounding heart
  • Severe allergic reactions (hives, welts, swelling on face, eyelids, lips, tongue, mouth, or throat)

Wrap Up

Symbicort is for daily control. It keeps airways calm and helps prevent flare-ups before they happen. On the other hand, albuterol steps in during sudden breathing trouble to bring fast relief.

Knowing when to use each medicine matters. If you reach for your rescue inhaler too often, that may be a sign your daily control is not strong enough. Talk with your doctor if that happens. Also, watch for side effects, as both medicines have risks you should understand.

Frequently Asked Questions

Can I use albuterol and Symbicort together?

Yes! Many doctors prescribe both. Symbicort helps manage asthma daily, and albuterol gives fast relief when symptoms flare.

Do I still need albuterol if I’m on Symbicort?

Usually, yes. Even if you take Symbicort every day, you may still need albuterol for sudden breathing problems—unless your doctor says Symbicort can cover both.

Is it safe to use Symbicort for a long time?

Yes! It’s meant for long-term use to help prevent asthma symptoms. Always follow your doctor’s instructions.

When should I call my doctor about asthma meds?

Call if you’re using albuterol more often, have side effects that don’t go away, or feel like your asthma is getting worse.

Sources

  • Jenkins, C., Kolarikova, R., Kuna, P., Caillaud, D., Sanchis, J., Popp, W., & Pettersson, E. (2006). Efficacy and safety of high-dose budesonide/formoterol (Symbicort) compared with budesonide administered either concomitantly with formoterol or alone in patients with persistent symptomatic asthma. Respirology, 11(3), 276–286. https://doi.org/10.1111/j.1440-1843.2006.00856.x
  • Chipps, B. E., Albers, F. C., Reilly, L., Johnsson, E., Cappelletti, C., & Papi, A. (2021). Efficacy and safety of as-needed albuterol/budesonide versus albuterol in adults and children aged ≥4 years with moderate-to-severe asthma: Rationale and design of the randomised, double-blind, active-controlled MANDALA study. BMJ Open Respiratory Research, 8(1), e001077. https://doi.org/10.1136/bmjresp-2021-001077
  • Nelson, H., Kemp, J. P., Bieler, S., Vaughan, L. M., & Hill, M. R. (1999). Comparative efficacy and safety of albuterol sulfate Spiros inhaler and albuterol metered-dose inhaler in asthma. Chest, 115(2), 329–335. https://doi.org/10.1378/chest.115.2.329
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