Gina, you have already had 13 responses to your letter by the time I am writing this to you, but I hope you will read this and I hope it will help. Some of your current responses are good, some are not so good...but I will try to clear up some things. I am a respiratory therapist who is getting certified as an asthma educator. First of all, Symbicort is what we call a controller or a preventive medication. It is actually a combination of two kinds of medicines. The first is called budesonide (brand name: Pulmicort, which is an inhaled corticosteroid. The second is called formoterol (brand name: Foradil), which is a long acting bronchodilator. So what does that mean? The corticosteroid is an anti-inflammatory (also known as an anti- asthmatic) medication that is targeted to act only in the lungs. It has very few systemic affects, which means that it does not affect the heart or other organs in the body. Because it has "steroid" in it's name, people get all worried about it, but it is not an anabolic steroid. It does not cause weight gain, bulking, or any of the other bad things that anabolic steroids can. Like I said, it targets the lungs and works to decrease inflammation in the airways. The bronchodilator works to relax the smoothe muscles that surround the airways, which causes them to dilate (open up) and allows for better airflow to occur. This helps decrease the dyspnea (shortness of breath) associated with asthma. As I said, Symbicort is a controller medication, which means it works to keep your asthma under control. It does take a few weeks, usually two, to begin to feel the effects of the medication, and you do have to continue to use it even if you feel good. It keeps you feeling good, keeps the exacerbations away. Also, you DO have to rinse or gargle after taking the medicine, in order to keep your mouth and throat from getting a "thrush-like" side affect. Now, let's talk about asthma. Asthma is a chronic disease, which means that it never goes completely away, although some people are very well controlled even with a minimum of medications. The importance of this fact is...don't be fooled into thinking that you can cure asthma and never have to deal with it again. Even if you have not had an exacerbation (asthma attack or episode) for years, an asthmatic should always be prepared in case something causes them to have problems. That means you should always have a "rescue" medication with you. The Albuterol nebulizer treatments that you are taking are an example of a rescue medication. Albuterol is a short acting bronchodilator. So what is the difference between that and the long acting bronchodilator in the Symbicort? One is long acting, and the other is short acting. Great, that helps a lot. OK, this is a better explanation. The long acting bronchodilator works slowly, but for a longer period of time (12 to 24 hours) to open up the airways. The short acting bronchodilator works very quickly (within minutes) to open the airways, but it only lasts for about 3 to 4 hours, so it has to be taken again if the dyspnea comes back. That is why it is called a rescue medication, because it will work quickly to get you breathing better again. So, I kinda got sidetracked again. Back to what asthma is. People who have asthma have airways that are hyper-responsive to some "trigger" or "triggers" which then causes inflammation, mucosal swelling, broncho-constriction and increased mucus production in the lungs. All these things work together to make it harder for air to move into and (especially) out of the lungs. This can cause air-trapping and eventually reduces oxygen/carbon dioxide exchange to occur. Which can lead to respiratory distress and even respiratory arrest. Approximately 5000 people die every year from asthma...it is not something to mess around with. So why does this happen. Well, most people believe it is an allergic response. Not everyone who has allergies has asthma, but EVERYONE who has asthma has allergies. These allergies are sometimes called "triggers". Hey, didn't I mention that word before? Triggers are anything that causes you to have an asthma attack. Common triggers are things like pollen, weeds, mold, dust, pet dander, SMOKING and strong fumes. So if you smoke, or people around you smoke, it needs to stop! The sooner the better. But there are some other triggers that are not as well known, such as cockroaches, mice, cold weather, hot humid weather, smog, exercise, aspirin, and strong emotions. Huh? Yes, strong emotions, like crying real hard, laughing real hard, stress, and worrying...(anxiety). Wow! That is a problem. And you say aspirin and exercise are on that list also? Yep, if you are sensitive to aspirin or any other of the NSAIDs (Non-steroidal anti-inflammatory drugs). And exercise can be a trigger, but there are simple steps that can be taken to allow the asthmatic to exercise without problems. Oh yeah, did I mention upper respiratory infections can also be triggers? Things like...bronchitis. So what should you do. I feel that education is the best way to fight the feelings of helplessness that you might have right now. That is why I have written you a book tonight. Start like this. Keep a diary to try and figure out what your triggers are, you probably have more than one. Once you know what causes you problems, then you can try to avoid or reduce exposure to these triggers so that you don't have an attack. Talk to your doctor to see if they can recommend an asthma education program for you to use. They can tell you many ways to help remove or reduce allergens in your home and work place. If you and your doctor determine that pollens and animal danders cause you problems, you can see if Singulair or some other allergy remedies are helpful. Take your Symbicort as prescribed, and make sure you have an Albuterol inhaler with you at all times. Use it correctly and don't over use it. If you are having to use it too much, go see the doctor or go to the emergency room, because you may need to get some oral or IV steroids to get you over the exacerbation. Or you may just have to step up the regimine you are currently on for a while. Educate yourself. Go to www.lungusa.com or look up the American Lung Association website for good information about asthma. One other thing that I didn't mention before. If you suffer from acid reflux or GERD, that can also trigger asthma problems. If you are aware of this being a problem for you, then you should talk to your doctor to about getting a prescription for that condition also. It will help keep the asthma problems down. Basically you should talk to your doctor about things you can do to keep your asthma from limiting your activities, because if you are feeling upset about being unable to do the things you want to do, then you are just going to have more problems from the asthma and the anxiety. It will become a viscious cycle. See if he or she can give you an "asthma action plan". This is a step by step plan to follow to let you know when to step up medications, and when to go to the doctor or the emergency room. Asthma is not the end of the world as you know it. It can be well controlled and you can live a mostly normal life. I hope that you will get some benefit from the info I have given you. I hope that you will educate youself and take contro of your asthma, and I hope you have a great life. If you want more info you can call me at ###-###-#### tues thru friday from 6:30 am til 4:00 pm. I will be happy to help you more if I can. Thanks for reading this. D.