Symbicort vs Alternatives: What Works Best for Asthma and COPD?

If you’re using Symbicort for asthma or COPD, you’ve probably wondered: are there better, cheaper, or simpler options? You’re not alone. Many people on this medication ask the same thing-especially when the cost goes up, or side effects like throat irritation or a fast heartbeat start to bother them. The truth is, Symbicort isn’t the only inhaler that works. There are others that do the same job, sometimes better for certain people. But not all alternatives are created equal. Some need more steps. Some cost more. Some don’t work as well for COPD. Let’s cut through the noise and show you exactly what’s out there, what each one does, and who they’re really best for.

What Symbicort Actually Does

Symbicort is a combination inhaler with two active ingredients: budesonide and formoterol. Budesonide is a corticosteroid that reduces swelling and mucus in your airways. Formoterol is a long-acting beta-agonist (LABA) that relaxes the muscles around your airways so you can breathe easier. Together, they tackle both the inflammation and the narrowing that make asthma and COPD worse.

It’s designed for daily use-not as a rescue inhaler. You take it twice a day, usually 12 hours apart. Most people start feeling better in a few days, but full control can take weeks. It’s approved for both asthma (in adults and kids 6+) and COPD (adults only). That’s important: not all inhalers work for both conditions.

Why People Look for Alternatives

People switch from Symbicort for a few clear reasons:

• Cost: In the UK, Symbicort costs around £30-£40 per inhaler without a prescription. Even with a prescription, the co-pay can add up over time.
• Side effects: Hoarseness, oral thrush, shaky hands, or a racing heart are common. Not everyone tolerates formoterol well.
• Device issues: Some find the Symbicort Turbuhaler hard to coordinate with breathing. Others dislike the taste.
• Effectiveness: A small group just don’t respond well to formoterol, even if they respond to other LABAs like salmeterol or vilanterol.

Switching isn’t about quitting-it’s about finding a better fit. And that’s possible.

Generic Budesonide/Formoterol: The Direct Alternative

The closest thing to Symbicort is the generic version: budesonide/formoterol. It’s the same two drugs, same doses, same delivery system. In the UK, generic versions are available through the NHS and private pharmacies. Brands like Rulide or Budesonide/Formoterol Teva are common.

Here’s the thing: it’s not just cheaper. It’s often the same exact medicine. The NHS switched to generics in 2023 to save money, and studies show no drop in effectiveness or increase in side effects. If your doctor says you can switch, this is the easiest, safest first step.

Cost? Around £15-£20 per inhaler. That’s nearly half the price.

Advair Diskus: The Closest Competitor

Advair Diskus (fluticasone/salmeterol) is the most common alternative in the US, and it’s available in the UK too. It’s also a combination inhaler: one steroid, one LABA. But here’s the difference:

• Fluticasone (in Advair) is a stronger steroid than budesonide. That means it might control inflammation better in some people-but it also raises the risk of oral thrush and bone thinning with long-term use.
• Salmeterol takes longer to kick in than formoterol. It can take 30 minutes to start working. Formoterol starts in 1-3 minutes. For people with sudden breathlessness, that matters.
• Advair uses a Diskus device. Some users find it easier to use than Symbicort’s Turbuhaler. Others find it clunkier.

Advair is often used for asthma, but it’s also approved for COPD. However, in the UK, it’s less commonly prescribed than Symbicort because of cost and the preference for formoterol’s faster onset.

Fostair: A UK-Friendly Option

Fostair (beclometasone/formoterol) is another combination inhaler, and it’s widely used in the UK. It’s not as well known abroad, but it’s a solid alternative. Beclometasone is another steroid, and like budesonide, it’s effective with fewer systemic side effects than fluticasone.

Here’s why Fostair stands out:

• It’s available in two strengths: 100/6 and 200/6. That gives more flexibility for dosing.
• The device is a pressurized metered-dose inhaler (pMDI), which means you need to coordinate your breath with the spray. This can be harder for older adults or those with shaky hands.
• It’s often cheaper than Symbicort and sometimes covered by NHS prescribing guidelines for COPD.

Many UK respiratory specialists prefer Fostair for patients who need a pMDI or who can’t use Turbuhalers. It’s not better than Symbicort-it’s just different. And sometimes, different works better.

Ultibro Breezhaler: For COPD-Only Patients

If you have COPD and not asthma, Ultibro Breezhaler (indacaterol/glycopyrronium) is worth considering. It’s a dual bronchodilator: no steroid at all. It’s designed for long-term maintenance in COPD, not asthma.

Why consider it?

• No steroid means no risk of thrush, voice changes, or bone loss.
• It’s once-daily. That’s easier than twice-daily Symbicort.
• Studies show it reduces flare-ups better than some combination inhalers in moderate-to-severe COPD.

But here’s the catch: if you have asthma, Ultibro isn’t approved. And if you’re still having inflammation or frequent coughing with mucus, skipping the steroid could make things worse. This is only for COPD patients who don’t need anti-inflammatory treatment.

Single-Ingredient Inhalers: The Step-Back Option

Some people don’t need both drugs together. Maybe your inflammation is under control, but you still need a bronchodilator. Or maybe your bronchodilator is fine, but you need a stronger steroid.

In those cases, using two separate inhalers can be smarter:

• For steroid-only: Fluticasone (Flixotide), Budesonide (Pulmicort), or Beclometasone (Qvar).
• For LABA-only: Salmeterol (Serevent), Formoterol (Oxis), or Vilanterol (in Anoro or Relvar).

Using two inhalers means more steps, more devices, and more chances to forget one. But it also gives you more control over dosing. If your asthma flares up, you can increase the steroid without touching the bronchodilator. Some patients find this flexibility helps them avoid overuse of LABAs.

It’s not for everyone-but if you’re struggling with side effects from the combo, or your doctor wants to fine-tune your treatment, this is a valid path.

What About Newer Inhalers Like Breztri or Trelegy?

Breztri Aerosphere (budesonide/formoterol/glycopyrronium) and Trelegy Ellipta (fluticasone/umeclidinium/vilanterol) are triple-therapy inhalers. They combine a steroid + two bronchodilators. They’re approved for COPD, especially if you’ve had flare-ups despite using dual therapy.

For asthma? Not approved. For COPD? Potentially powerful. But they’re expensive. In the UK, they’re usually only prescribed after you’ve tried Symbicort or Fostair and still have symptoms or frequent exacerbations.

They’re not a first-line alternative. They’re a next-step option. If you’re still struggling after 6-12 months on Symbicort, your specialist might consider this. But for most people, it’s overkill.

Choosing the Right Alternative: A Simple Guide

Here’s how to pick:

1. Are you on Symbicort because of asthma? Stick with combo inhalers: generic budesonide/formoterol, Advair, or Fostair.
2. Are you on Symbicort because of COPD? Consider Fostair, Ultibro (if no steroid needed), or if you’re still having flare-ups, talk to your doctor about triple therapy.
3. Do you hate the Turbuhaler? Try Fostair (pMDI) or Advair (Diskus).
4. Is cost a problem? Generic budesonide/formoterol is your best bet.
5. Do you get thrush or hoarseness? Rinse your mouth after every use-no matter which inhaler you use. Switching inhalers won’t fix this if you don’t rinse.

There’s no single best alternative. The right one depends on your condition, your body, your habits, and your budget.

What Not to Do

Don’t switch on your own. Don’t stop Symbicort suddenly. Even if you feel fine, your airways might still be inflamed. Stopping steroids too fast can cause a severe flare-up.

Don’t assume a cheaper inhaler is weaker. Generics are just as effective.

Don’t ignore device technique. A poorly used inhaler-no matter how expensive-won’t help. Ask your nurse or pharmacist to watch you use it. Most people use their inhalers wrong.

Final Thoughts

Symbicort works well for millions. But it’s not the only option. The UK healthcare system offers several effective alternatives, from generics to different devices to single-ingredient regimens. The key isn’t finding the ‘best’ inhaler-it’s finding the one that fits your life, your symptoms, and your body.

If you’ve been on Symbicort for a while and it’s not working as well as it used to-or if it’s costing you too much or causing side effects-talk to your GP or respiratory nurse. There’s probably a better fit out there. You just need to ask.