Turbuhaler^® contains up to 200 doses of medication stored in a reservoir. The micronised drug in Turbuhaler^® does not contain carrier particles, but in some formulations the active drug is diluted with lactose particles of the same size. Turning the grip of the inhaler rotates the dosing disc and drug fills the dose-metering holes. As the patient inhales, air passes through the dosing disc and lifts the dose. The small powder pellets disintegrate into their primary particles when passing through the mouthpiece during the inhalation process.

See Turbuhaler^® function live!

The Turbuhaler^® system is not only built on an advanced inhaler technology but also uses a specific pharmaceutical formulation of the drugs. See for example below the process for budesonide which is used in Pulmicort^®, Rhinocort^® and is one of the active ingredients in Symbicort^®.



Before milling, budesonide has the appearance of rod-like crystals with a varying size of 300-500 µm.

The micronisation (milling) process reduces the particle size to a few microns. After this treatment the crystals lose their characteristic shape.

A close-up of a spheronised powder. Note difference in enlargement between figures.

The small, 2-4 µm particles are tumbled to form larger spheres (see above figures). The resulting spheres have good flow properties, and the method is the same irrespective of whether the pharmaceutical formulation contains pure drug (Bricanyl^®, Pulmicort^® and Rhinocort^®) or a mixture of pure drug(s) and micronised lactose (Oxis^® and Symbicort^®).

To protect the drug from humidity at storage and absorbing the humidity in the inhaler after inhalation, Turbuhaler^® contains an internal desiccant (drying agent).


See more of the Turbuhaler^® powder concept.

It is easy to use Turbuhaler^® because of its simple design and breath-actuated operation. There are only a few actions for the patient to follow, these are:

• Unscrew the protective cover.
• Hold Turbuhaler^® in an upright position and twist the grip in one direction as far as it will go, and then back again.
• Breathe out, however not through Turbuhaler^®.
• Place the mouthpiece between the teeth and close the lips around it.
• Breathe in forcefully and deeply.
• Remove Turbuhaler^® from the mouth and breathe out.
• Replace protective cover.

See how to use Turbuhaler^®!
Read how to use Turbuhaler^®

The force created for inhalation generates a flow through the inhaler that disaggregates the powder into fine particles and opens up the airways to facilitate good lung deposition. The dose leaves Turbuhaler^® very early during inhalation (within the first few hundred millilitres of inhaled air). Thus, the inhaled volume is of less importance when using a dry powder inhaler. It is a common misunderstanding that an inhaler with a low inherent resistance is a better inhaler; in reality it may be the reverse. Svartengren et al (1995) demonstrated that inhalation against resistance resulted in a marked increase in lung deposition and a reduced variability in lung dose compared with inhalation against no resistance. A high lung deposition will reduce the oropharyngeal drug deposition and reduce the risk of local side effects such as cough, dysphonia and candidiasis
(Read more on local side effects).

In contrast to pMDIs, Turbuhaler^® makes no sound when the drug is released. Moreover, since the amount of drug delivered by Turbuhaler^® is small, there is either no or only a faint taste in the mouth when the drug is delivered. This can, in some cases, lead to patients being uncertain as to whether they have received the required dose. Correct functioning can be easily checked by inhaling through a piece of dark cloth (Figure), although it is important that patients are aware this is a check of the efficiency of their inhalation technique and not a treatment.

Note that the actual amount of powder is less than shown in the picture.

The dose indicator for Symbicort^® Turbuhaler^® indicates from beginning to the end of the in-use period the remaining number of doses, whilst the other members of the Turbuhaler^® family indicate with a red mark when 20 doses remain.

Note that the "rattling" sound when shaking the inhaler does not indicate that there is drug left in the inhaler. The sound comes from the desiccant, which is there to absorb any humidity that may enter the inhaler.

Turbuhaler^® should be held in an upright position at loading - this means that the angle of the inhaler should be less than 45 degrees from vertical. This is to ensure that the dosing disc is filled with the correct amount of drug powder at loading/activation. After loading, i.e. at inhalation of the drug, there are no restrictions - irrespective of position of the inhaler the same amount of drug will be inhaled.

No. As discussed above, the dose leaves the inhaler within the first few hundred millilitres of inhaled air. Thus, when performing a normal inhalation the drug will follow the inhaled air down into the lungs and will have time to settle in the lungs before exhalation.

The amount of exhaled drug after using a dry powder inhaler has been measured and is typically below 1% of the nominal dose (Biddiscombe et al, 1993).

This may differ between Turbuhaler^® products. Please, consult local prescribing information.

Most questions asked by patients can be answered by the information provided here. In addition, on the AstraZeneca information site for patients prescribed Symbicort^® are some additional frequently asked questions and answers that have been collected from patients.