Symbicort Turbuhaler 60MD vs Top Asthma Inhaler Alternatives - 2025 Comparison

Quick Takeaways

• Symbicort Turbuhaler delivers a 60µg budesonide+12µg formoterol dose per inhalation via a DPI.
• Advair Diskus, Breo Ellipta and Relvar Ellipta offer once‑daily dosing but use different steroids.
• Dulera pairs formoterol with mometasone, useful for patients needing a lower‑dose steroid.
• Pure budesonide inhalers (Pulmicort) work well when a LABA isn’t required.
• Device preference (DPI vs MDI) and insurance coverage often decide the final choice.

Symbicort Turbuhaler 60µg is a dry‑powder inhaler (DPI) that combines the long‑acting β₂‑agonist formoterol (12µg) with the inhaled corticosteroid budesonide (60µg) for maintenance therapy of asthma and chronic obstructive pulmonary disease (COPD).

How Symbicort Works and Who It’s For

Formoterol relaxes airway smooth muscle by stimulating β₂‑adrenergic receptors, delivering quick bronchodilation that lasts up to 12hours. Budesonide reduces airway inflammation by binding glucocorticoid receptors and inhibiting cytokine production. The combination lets patients control symptoms with a single inhaler, typically two puffs twice daily. Clinical guidelines (GINA 2025) place this regimen in Step3‑4 for moderate‑to‑severe asthma, especially when “single‑maintenance and reliever therapy” (SMART) is desired.

Key Decision Factors When Choosing an Inhaler

Choosing an alternative isn’t just about the drug; it’s about the whole package. Below are the most common criteria patients and clinicians weigh:

• Device type: DPIs (Symbicort, Advair Diskus, Breo Ellipta) require a strong inhalation flow, whereas metered‑dose inhalers (MDIs) rely on a propellant.
• dosing frequency: Once‑daily options improve adherence for busy lifestyles.
• Steroid potency: Budesonide (low‑to‑moderate potency) vs fluticasone propionate/furoate (high potency).
• Side‑effect profile: Higher steroid doses increase risk of oral thrush and dysphonia.
• Cost & insurance coverage: Generic budesonide inhalers are cheaper; brand‑name combinations can vary widely.

Head‑to‑Head Comparison of Popular ICS/LABA Combinations

Deep Dive into Each Alternative

Advair Diskus (fluticasone+salmeterol)

Advair pairs a high‑potency steroid (fluticasone propionate) with a LABA that lasts up to 12hours, mirroring Symbicort’s bronchodilator effect but delivering a larger steroid dose per puff. It’s favored for severe asthma where tighter inflammation control is needed. Because the device is a DPI, patients must generate a flow rate of at least 60L/min to ensure full dose delivery - a common hurdle for very young children or frail elderly.

Breo Ellipta (fluticasone+vilanterol)

Breo’s biggest selling point is once‑daily dosing. Vilanterol is a newer LABA with a 24‑hour duration, meaning the inhaler can be taken every morning. The fluticasone dose (100µg) is roughly equivalent to two puffs of Symbicort, making it a good switch for patients wanting fewer daily steps. The Ellipta device has a “click‑and‑go” design that many find easier than the Turbuhaler’s rotating mechanism.

Dulera (mometasone+formoterol)

Dulera uses mometasone furoate, a steroid with potency similar to budesonide but a slightly longer half‑life. The combo keeps the fast onset of formoterol, which can double as a rescue inhaler under the SMART protocol. It’s an attractive option for children aged six and up because the dosage can be titrated more finely (quarter‑puff capability).

Relvar Ellipta (fluticasone furoate+vilanterol)

Relvar delivers the highest‑potency steroid in the group-fluticasone furoate-at a low 100µg dose, paired with a 24‑hour LABA. For patients with severe persistent asthma who struggle with twice‑daily regimens, Relvar offers round‑the‑clock coverage with just one inhalation each day. Its Ellipta device shares the same user‑friendly features as Breo.

Pulmicort (budesonide monotherapy)

When a LABA isn’t medically indicated-such as in mild asthma or in patients who experience LABA‑related tachycardia-Pulmicort provides pure anti‑inflammatory action. It’s available as a DPI (Pulmicort Turbuhaler) and as nebulized suspension. The DPI version matches the budesonide dose of Symbicort but requires a separate rescue inhaler for bronchodilation.

Best‑Fit Scenarios: Matching Patient Needs to an Inhaler

Once‑daily adherence champion: Patients who forget doses or have busy mornings often succeed with Breo Ellipta or Relvar Ellipta.

Low‑dose steroid preference: If oral‑corticosteroid side effects are a concern, the budesonide‑formoterol combo in Symbicort or Dulera offers the gentlest steroid exposure while still providing bronchodilation.

Kids and dexterity challenges: The Turbuhaler’s twist‑to‑activate mechanism can be tricky for small hands; the Ellipta click‑and‑release design is generally easier for children over six.

Cost‑sensitive patients: Generic budesonide inhalers (e.g., generic Turbuhaler equivalents) and Pulmicort nebulizer solutions are often covered by Medicare and many private plans, keeping out‑of‑pocket costs under $50.

Severe asthma requiring high‑potency steroid: Advair Diskus or Relvar Ellipta deliver higher fluticasone doses, which can reduce exacerbations in patients who haven’t responded to moderate doses.

Practical Tips for Getting the Most Out of Your Inhaler

1. Check your inhalation technique every 3‑6months with a pharmacist or respiratory therapist.
2. Never shake a DPI; instead, prime it by loading a dose and exhaling away from the mouth.
3. Rinse your mouth after each use to lower the risk of oral thrush.
4. Store the inhaler at room temperature, away from humidity; a dry environment preserves dose integrity.
5. If you miss a dose, take it as soon as you remember unless it’s almost time for the next scheduled puff-don’t double‑dose.

When to Switch or Escalate Therapy

If you experience two or more exacerbations per year, nighttime awakenings more than twice a month, or persistent wheeze despite proper technique, it’s time to discuss an upgrade. Options include moving from a twice‑daily to a once‑daily high‑potency product, adding a long‑acting muscarinic antagonist (LAMA) like tiotropium, or incorporating biologic therapy (e.g., omalizumab) for severe eosinophilic asthma.

Frequently Asked Questions

Is Symbicort suitable for children?

Symbicort is approved for patients aged 12years and older for asthma, and from 6years for COPD in some regions. For younger children, doctors often prefer a lower‑dose budesonide‑only inhaler or a pediatric‑specific combo like Dulera, which offers quarter‑puff dosing.

Can I use Symbicort as a rescue inhaler?

Yes, under the SMART (Single‑Maintenance And Reliever Therapy) protocol, a patient can take one extra puff of Symbicort for sudden symptom relief. This approach is backed by GINA 2025 but requires physician supervision.

How does the Turbuhaler differ from an MDI?

A Turbuhaler is a dry‑powder inhaler that releases medication when you inhale sharply; it has no propellant. An MDI (metered‑dose inhaler) releases a mist when you press a canister, requiring coordination between actuation and inhalation. DPIs tend to be breath‑actuated, which can be easier for people with arthritis but harder for those with low inspiratory flow.

What are the main side effects of the budesonide‑formoterol combo?

Common side effects include hoarseness, oral thrush, cough, and occasional tremor or palpitations from formoterol. Rinsing the mouth after each use and using the lowest effective dose can mitigate most problems.

Is there a generic version of Symbicort?

As of 2025, no generic budesonide‑formoterol DPI has been approved in the United States, though some European markets have approved a generic called “Foster.” Patients should check with their insurer for coverage alternatives.

Which inhaler offers the best once‑daily control?

Breo Ellipta and Relvar Ellipta are the leading once‑daily options. They pair a 24‑hour LABA (vilanterol) with a high‑potency steroid, providing steady coverage with a single morning puff.