Treating Moderate Persistent Asthma with Symbicort

Author’s Note: Denise is not my patient; she is a gym friend gracious enough to share her asthma history with me. In exchange, I promised to alter the details of her history to protect her anonymity. However, her triumph over moderate persistent asthma story is not a work of fiction but an authentic and inspiring journey.

I met Denise at the gym last year. She did not realize I was a physician, and I was surprised to learn that she was 45, as she looked at least 20 years younger. Denise was fitter than most of the twenty-somethings at the gym, and certainly fitter than I am—though I might use the excuse of being 15 years older.

I noticed that Denise would take two puffs of an asthma inhaler about thirty minutes before starting her workout. As a pulmonologist, I often recommend this to my asthma patients, so I recognized that Denise likely has exercise-induced asthma.

I asked Denise about this, and she confirmed that she had moderate persistent asthma. She agreed to provide details of her asthma history if I protected her identity.

A Young Mother Struggles to Breathe

At 36 years old, Denise, a mother of three young children, began experiencing worsening respiratory symptoms over several months. She reported wheezing, shortness of breath, and persistent coughing, particularly at night and in the early morning. These symptoms progressively intensified over six months, leading to difficulty sleeping and significant disruptions in her daily activities, including her ability to exercise and carry out routine tasks.

Denise described her asthma symptoms as occurring nearly daily, with nocturnal awakenings at least once a week due to coughing and shortness of breath. She noted that her symptoms are often triggered by exposure to cold air, dust, and intense physical activity. Additionally, Denise reported that upper respiratory infections and seasonal allergens frequently caused severe asthma attacks.

Denise had been managing her asthma with an as-needed use of a short-acting beta-agonist (rescue) inhaler. However, she noticed an increased reliance on the inhaler, using it multiple times daily with diminishing relief. Despite this, Denise had not required emergency medical attention or hospital admission for her asthma symptoms.

Denise had no history of smoking and reported no significant changes in her environment or lifestyle that could explain the worsening symptoms. She had not experienced significant weight gain or loss, nor did she report symptoms such as chest pain, palpitations, or unexplained fatigue. However, Denise did acknowledge a recent increase in stress due to work-related pressures, which she believed might be contributing to her symptoms.

Asthma Treatment with Symbicort

Symbicort (budesonide/formoterol) is a combination inhaler that includes both an inhaled corticosteroid and a long-acting beta-2-agonist. Budesonide, the corticosteroid component, helps reduce airway inflammation, while formoterol, the long-acting beta-2-agonist, provides bronchodilation to prevent and relieve bronchospasm.

Denise was instructed to use Symbicort 160/4.5 mcg, with two inhalations twice daily (morning and evening), to manage her daily symptoms and prevent exacerbations.

Additionally, Denise was advised to use an extra inhalation of Symbicort as needed for acute relief of asthma symptoms. This approach, known as SMART (Single Maintenance and Reliever Therapy), integrates both maintenance and reliever therapy into a single regimen, simplifying treatment and improving adherence.

Follow-up While Taking Symbicort

Regular follow-up visits were scheduled to monitor Denise’s response to treatment. Periodic pulmonary function tests and asthma control questionnaires were conducted to evaluate the effectiveness of the therapy. Denise was also educated on proper inhaler techniques to ensure optimal drug delivery. The treatment plan would be adjusted based on Denise’s symptoms, lung function, and any side effects experienced.

Things to Remember When Taking Symbicort

Symbicort is generally well-tolerated; however, Denise was informed about potential side effects. These may include oral thrush, hoarseness or dysphonia, and tremors or palpitations due to the beta-agonist component. Long-term use could also lead to systemic effects such as adrenal suppression or osteoporosis. Denise was advised to rinse her mouth after each use of the inhaler to minimize the risk of oral thrush and to promptly report any side effects to her healthcare provider.

Victory Over Asthma with Symbicort

At 46, this mother of two is a dedicated CrossFit enthusiast, training six days a week with intensity and endurance that rivals—and often surpasses—women twenty years her junior. Denise’s remarkable athletic performance is due to her effective management of moderate persistent asthma with Symbicort. Since starting the treatment, she has experienced a significant reduction in asthma symptoms, allowing her to push her physical limits without the fear of sudden breathlessness or fatigue. Denise’s story demonstrates how successful asthma management can enable individuals to excel in high-intensity physical activities, regardless of age.

If you or someone you care about is experiencing asthma symptoms that are not well-controlled with current medications, consulting a healthcare provider is crucial. Uncontrolled asthma can lead to frequent symptoms, reduced quality of life, and severe complications, including life-threatening asthma attacks. A healthcare provider can evaluate the situation, adjust the treatment plan, and consider options such as adding or switching to a combination inhaler like Symbicort. Timely intervention is essential for preventing exacerbations, improving lung function, and managing asthma effectively, thereby supporting a healthier, more active lifestyle.