Symbicort alternatives: what to try when budesonide/formoterol isn't right

If Symbicort (budesonide + formoterol) isn't working, causes side effects, or is too expensive, you have real options. Some alternatives change the active drug, others change how the drug is delivered, and a few are for more severe cases. Below I lay out the common choices and simple tips to help you and your doctor pick the best one.

Common inhaler alternatives

Here are inhaler-based options you’ll hear about in clinics:

• Advair / AirFluSal (fluticasone + salmeterol) — another widely used ICS/LABA combo. Works for many people who don’t respond to budesonide/formoterol.
• Breo Ellipta (fluticasone + vilanterol) — once-daily option that some patients prefer for convenience.
• Dulera (mometasone + formoterol) — similar action to Symbicort but with a different steroid; worth trying if you react to one steroid type.
• LAMA options (long-acting muscarinic antagonists) such as tiotropium (Spiriva) — often added for COPD or as an add-on in asthma when inhaled steroids alone aren’t enough.
• Combination LAMA/LABA inhalers — for those needing stronger bronchodilation; used more in COPD but sometimes in difficult asthma cases.
• Rescue inhalers (albuterol/salbutamol) — not an alternative controller, but essential for quick symptom relief.

Also ask about generic versions of budesonide/formoterol. Generics can cut costs without changing treatment effect.

Non-inhaler options and practical tips

For severe or allergic asthma, biologic drugs may help. Names to know: omalizumab (Xolair), mepolizumab (Nucala), benralizumab (Fasenra), and dupilumab (Dupixent). These are injections given under medical supervision and target specific immune pathways. They’re not first-line but can reduce steroid need and hospital visits for the right patients.

Practical tips that matter:

• Match the inhaler to your breathing pattern: some people do better with a press-and-breathe MDI plus spacer; others prefer a dry powder inhaler (DPI).
• Watch for steroid side effects: oral thrush and hoarseness are common—rinsing your mouth after use helps a lot.
• Check cost and coverage: ask your pharmacist about generics, coupons, or mail-order savings before switching.
• Don’t stop suddenly: if you want to stop Symbicort, talk to your clinician—abrupt changes can cause flare-ups.
• Technique matters more than brand: many people get better control just by fixing how they inhale.

If you’re thinking about a switch, bring a list of your symptoms, how often you use a rescue inhaler, and any side effects to your appointment. Your doctor can compare lung tests, your history, and cost/coverage to recommend the best alternative. Want help phrasing questions for your clinician? I can draft a quick checklist you can take to your visit.