- If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet. See section 4.

What is in this leaflet

What Budesonide/For­moterol Teva is and what it is used for (page 3)

What you need to know before you use Budesonide/For­moterol Teva (page 5

How to use Budesonide/For­moterol Teva (page 9)

Possible side effects (page 18)

How to store Budesonide/For­moterol Teva (page 21)

Contents of the pack and other information (page 22)

What Budesonide/For­moterol Teva is and what it is

Budesonide/For­moterol Teva contains two different active substances: budesonide and formoterol fumarate dihydrate.

• Budesonide belongs to a group of medicines called ‘corticosteroids’ also known as ‘steroids’. It works by reducing and preventing swelling and inflammation in your lungs and helps you to breathe more easily.
• Formoterol fumarate dihydrate belongs to a group of medicines called ‘long-acting P2 adrenoceptor agonists’ or ‘bronchodilators’. It works by relaxing the muscles in your airways. This will help to open the airways and help you to breathe more easily.

Budesonide/For­moterol Teva is indicated for use in adults 18 years of age and older only.

Budesonide/For­moterol Teva is NOT indicated for use in children 12 years of age and younger or adolescents 13 to 17 years of age.

cribed this medicine to treat asthma or chronic obstructive pulmonary disease (COPD).

Asthma

To treat your asthma your doctor will prescribe two asthma inhalers: Budesonide/For­moterol Teva together with a separate ‘reliever inhaler’ such as salbutamol.

Use Budesonide/For­moterol Teva every day. This helps to prevent asthma symptoms such as breathlessness and wheezing from occurring.

Use the ‘reliever inhaler’ when you get asthma symptoms, to make it easier to breathe again.

Chronic obstructive pulmonary disease (COPD)

COPD is a long-term lung disease of the airways in the lungs, which is often caused by cigarette smoking.

Symptoms include shortness of breath, cough, chest discomfort and coughing up mucus.

Budesonide/For­moterol Teva can also be used to treat the symptoms of severe COPD in adults.

2. What you need to know before you use Budesonide/Formoterol Teva

Do not use Budesonide/For­moterol Teva if:

You are allergic to budesonide, formoterol fumarate dihydrate, or the other ingredient in this medicine (listed in section 6).

Warnings and precautions

Talk to your doctor, pharmacist or nurse before taking Budesonide/For­moterol Teva if

• you are diabetic.
• you have a lung infection.
• you have high blood pressure or you have ever had a heart problem (including an uneven heartbeat, a very fast pulse, narrowing of the arteries or heart failure).
• you have problems with your thyroid or adrenal glands.
• you have low levels of potassium in your blood.
• you have severe liver problems.

If you have been taking steroid tablets for your asthma or COPD, your doctor may reduce the number of tablets that you take, once you start to use Budesonide/For­moterol Teva. If you have been taking steroid tablets for a long time, your doctor may want you to have regular blood tests. When reducing steroid tablets, you may feel generally unwell even though your chest symptoms may be improving. You might experience symptoms such as a stuffy or runny nose, weakness or joint or muscle pain and rash (eczema). If any of these symptoms bother you, or if symptoms such as headache, tiredness, nausea (feeling sick) or vomiting (being sick) occur, please contact your doctor immediately. You may need to take other medicines if you develop allergic or arthritic symptoms. You should speak to your doctor ifyou are concerned as to whether you should continue to use Budesonide/For­moterol Teva.

Your doctor may consider adding steroid tablets to your usual treatment during periods of stress (for example, when you have a chest infection or before an operation).

Children and adolescents

This medicine should not be used in children or adolescents under the age of 18 years.

Other medicines and Budesonide/For­moterol Teva

Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines.

In particular, tell your doctor or pharmacist if you are taking any of the following medicines:

• £ blockers (such as atenolol or propranolol for high blood pressure or a heart condition), including eyedrops (such as timolol for glaucoma).
• Medicines for a fast or uneven heartbeat (such as quinidine, disopyramide and procainamide).
• Medicines like digoxin, often used to treat heart failure.
• Diuretics, also known as ‘water tablets’ (such as furosemide). These are used to treat high blood pressure.
• Steroid medicines that you take by mouth (such as prednisolone).
• Xanthine medicines (such as theophylline or aminophylline). These are often used to treat asthma.
• Other bronchodilators (such as salbutamol).
• Tricyclic antidepressants (such as amitriptyline) and the antidepressant nefazodone.
• Medicines called monoamine oxidase inhibitors (such as phenelzine, furazolidone and procardazine).
• Phenothiazine medicines (such as chlorpromazine and prochlorperazine).
• Medicines called ‘HIV protease inhibitors’ (such as ritonavir) to treat HIV infection.
• Medicines to treat infections (such as ketoconazole, itraconazole, voriconazole, posaconazole, clarithromycin and telithromycin).
• Medicines for Parkinson’s disease (such as levodopa).
• Medicines for thyroid problems (such as levothyroxine).
• Medicines for allergies or antihistamines (such as terfenadine).

If any of the above applies to you, or if you are not sure, talk to your doctor, pharmacist or nurse before using Budesonide/For­moterol Teva.

Also tell your doctor, pharmacist or nurse if you are going to have a general anaesthetic for an operation or for dental work.

Pregnancy, breast-feeding and fertility

• If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor, pharmacist or nurse for advice before taking Budesonide/For­moterol Teva – do NOT use this medicine unless your doctor tells you to.
• If you get pregnant while using Budesonide/For­moterol Teva, do NOT stop using Budesonide/For­moterol Teva but talk to your doctor immediately.

Driving and using machines

Budesonide/For­moterol Teva is not likely to affect your ability to drive or to use tools or machines.

Budesonide/For­moterol Teva contains lactose

Lactose is a type of sugar found in milk. Lactose contains small amounts of milk protein which may cause allergic reactions.If you have been told by your doctor that you have an intolerance to some sugars, talk to your doctor before using this medicine.

3. How to use Budesonide/Formoterol Teva

Always use this medicine exactly as your doctor or pharmacist has told you. Check with your doctor, pharmacist or nurse if you are not sure.

• It is important to use Budesonide/For­moterol Teva every day, even if you have no asthma or COPD symptoms at the time.
• If you are using Budesonide/For­moterol Teva for asthma, your doctor will want to regularly check your symptoms.

Asthma

d

Using Budesonide/For­moterol Teva and a separate ‘reliever inhaler’

Use your Budesonide/For­moterol Teva every day. This helps to prevent asthma symptoms from occurring.

Recommended dose:

Adults (18 years and older)

• 1 or 2 inhalations (actuations), twice a day.

Your doctor may increase this to 4 inhalations, twice a day.

If your symptoms are well controlled, your doctor may ask you to take your medicine once a day.

Your doctor will help you to manage your asthma and will adjust the dose of this medicine to the lowest dose that controls your asthma. If your doctor feels that you need a lower dose than is available from your Budesonide/For­moterol Teva, your doctor may prescribe an alternative inhaler containing the same active substances as your Budesonide/For­moterol Teva but with a lower dose of the corticosteroid. However, do not adjust the number of inhalations your doctor has prescribed without talking to your doctor first.

Use your separate ‘reliever inhaler’ to treat asthma symptoms when they happen.

Always keep your ‘reliever inhaler’ with you and use it to relieve sudden attacks of breathlessness and wheezing. Do not use Budesonide/For­moterol Teva to treat these asthma symptoms.

Use of your ‘reliever inhaler’ should not exceed 8 inhalations (puffs) in any 24 hours and you should not use your ‘reliever inhaler’ more often than every 4 hours. If you are regularly using up to 8 inhalations a day or you need to increase the amount of ‘reliever inhaler’ you require, you should see your doctor as soon as possible. Your doctor may need to change your treatment in order to reduce your symptoms of asthma (breathlessness, wheezing and cough) and improve your asthma control and make your breathing easier.

If you are doing exercise and you get asthma symptoms, use your separate ‘reliever inhaler’ to relieve these symptoms. Do not use Budesonide/For­moterol Teva just before exercise to stop asthma symptoms from occurring, use your separate ‘reliever inhaler’.

Chronic Obstructive Pulmonary Disease (COPD)

Recommended dose:

Adults (18 years and older): 2 inhalations twice a day.

Your doctor may also prescribe another bronchodilator medicine, for example an anticholinergic (such as tiotropium or ipratropium bromide) for your COPD disease.

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Preparing your new Budesonide/For­moterol Teva

Bf Bd d /F t !T f th r ,f fll

Before using your Budesonide/For­moterol Teva for the first time , you need to prepare it for use as follows:

• Check the dose indicator to see that there are 120 inhalations in the inhaler.
• Write the date you opened the foil pouch on the label of the inhaler.
• Do not shake your inhaler before use.

„ ,,k

How to take an inhalation

Every time you need to take an inhalation, follow the instructions below.

1. Hold your inhaler with the semi-transparent wine red mouthpiece cover at the bottom.

Open the mouthpiece cover by folding it down until one loud click is heard. Your medicine is actively

metered. Your inhaler is now ready for use.

• 3. Breathe out gently (as far as is comfortable). Do not breathe out through your inhaler.

• 4. Place the mouthpiece between your teeth. Do not bite the mouthpiece. Close your lips around the mouthpiece. Take care not to block the air vents.

Breathe in through your mouth as deeply and as hard as you can.

• 5. Hold your breath for 10 seconds or as long as you comfortably can.

• 6. Remove your inhaler from your mouth. You may notice a taste

  your inhalation.

  
  

• 7. Then breathe out gently (do not breathe out through the inhaler). Close the mouthpiece cover.

CLOSE

If you are to take a second inhalation, repeat steps 1 to 7.

Rinse your mouth with water after every dose, and spit it out.

Do not try to take your inhaler apart, remove or twist the mouthpiece cover, it is fixed to your inhaler and must not be taken off. Do not use your Spiromax if it has been damaged or if the mouthpiece has come apart from your Spiromax. Do not open and close the mouthpiece cover unless you are about to use your inhaler.

Cleaning your Spiromax

Keep your Spiromax dry and clean.

If necessary you may wipe the mouthpiece of your Spiromax after use with a dry cloth or tissue.

When to start using a new Spiromax

• The dose indicator tells you how many doses (inhalations) are left in your inhaler, starting with 120 inhalations when it is full.
• The dose indicator, on the rear of the device, shows the number of inhalations remaining in even numbers only.
• For inhalations remaining from 20 downwards to ‘8’, 6’,’4’,’2’ the numbers are displayed in red on a

white background. When the numbers become red in the window, you should consult your doctor and obtain a new inhaler.

Note:

• The mouthpiece will still ‘click’ even when your Spiromax is empty.
• If you open and close the mouthpiece without taking an inhalation the dose indicator will still register it as a count. This dose will be securely held inside the inhaler for when the next inhalation is due. It is impossible to accidentally take extra medicine or a double dose in one inhalation.

Keep the mouthpiece closed all the time unless you are about to use your inhaler.

Important information about your asthma or COPD symptoms

If you feel you are getting breathless or wheezy while using Budesonide/For­moterol Teva, you should continue to use Budesonide/For­moterol Teva but go to se additional treatment.

Contact your doctor immediately if:

• Your breathing is getting worse or you often wake up at night with breathlessness and wheezing.
• Your chest starts to feel tight in the morning or your chest tightness lasts longer than usual.

These signs could mean that your asthma or COPD is not being properly controlled and you may need different or additional treatment immediately.

Once your asthma is well controlled your doctor may consider it appropriate to gradually reduce the dose of

Budesonide/For­moterol Teva.

udesonide/For­moterol Teva than you should

t you take your dose as advised by your doctor. You should not exceed your prescribed

If you use more Budesonide/For­moterol Teva than you should, contact your doctor, pharmacist or nurse for advice.

The most common symptoms that may occur after if you use more Budesonide/For­moterol Teva than you should are trembling, headache or a rapid heartbeat.

If you forget to use Budesonide/For­moterol Teva

If you forget to take a dose, take it as soon as you remember. However do not take a double dose to make up for a forgotten dose. If it is nearly time for your next dose just take your next dose at the usual time.

If you become wheezy or breathless, or develop any other symptoms of an asthma attack, use your ‘reliever inhaler’, then seek medical advice.

If you stop using Budesonide/For­moterol Teva

Do not stop using your inhaler without telling your doctor first.

If you have any further questions on the use of this medicine, ask your doctor, pharmacist or nurse.

4. Possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them.

If any of the following happen to you, stop using Budesonide/For­moterol Teva and talk to your doctor immediately:

Rare side effects: may affect up to 1 in 1,000 people

• Swelling of your face, particularly around your mouth (tongue and/or throat and/or difficulty to swallow)

or hives together with difficulties to breathe (angioedema) and/or sudden feeling of faintness. This may mean that you are having an allergic reaction, which may also include rash and itching.

• Bronchospasm (tightening of the muscles in the airways which causes wheezing and shortness of breath). If the wheezing comes on suddenly after using this medicine stop using it and talk to your doctor immediately.

Very rare side effects: may affect up to 1 in 10,000 people

• Sudden acute wheezing and/or shortness of breath immei as ‘paradoxical bronchospasm’). If either of these symptoms occur, stop using Budesonide/For­moterol Teva straightaway and use your ‘reliever inhaler’. Contact your doctor immediately as you may need to have your treatment changed.

Other possible side effects:

Common: may affect up to 1 in 10 people

Palpitations (awareness of your heart beating), trembling or shaking. If these effects occur, they are usually mild and usually disappear as you continue to use Budesonide/For­moterol Teva.

Thrush (a fungal infection) in the mouth. This is less likely to occur if you rinse your mouth out with water after using your medicine.

Mild sore throat, coughing and a hoarse voice.

Headache.

Tell your doctor if you have any of the following while taking Budesonide/For­moterol Teva they could be symptoms of a lung infection:

• Fever or chills
• Increased mucus production, change in mucus colour
• Increased cough or increased breathing difficulties

Uncommon: may affect up to 1 in 100 people

• Feeling restless, nervous, agitated, anxious or angry.
• Disturbed sleep.
• Feeling dizzy.
• Nausea (feeling sick).
• Fast heartbeat.
• Bruising of the skin.
• Muscle cramps.

Rare:

• Low levels of potassium in your blood.
• Uneven heartbeat.

Very rare:

• Depression.
• Changes in behaviour, especially in children.
• Chest pain or tightness in the chest (angina pectoris).
• Disturbance of the heart’s electrical system (prolongation of the QTc-interval).
• An increase in the amount of sugar (glucose) in your blood.
• Taste changes, such as an unpleasant taste in the mouth.
• Changes in your blood pressure.
• Inhaled corticosteroids can affect the normal production of steroid hormones in your body, particularly if you use high doses for a long time. The effects include:

• – changes in bone mineral density (thinning of the bones)

• – cataract (clouding of the lens in the eye)

• – glaucoma (increased pressure in the eye)

• – a slowing of the rate of growth of children and adolescents

• – an effect on the adrenal gland (a small gland next to the kidney)

These effects happen very rarely and are much less likely to happen with inhaled corticosteroids than with corticosteroid tablets.

Reporting of side effects

If you get any side effects, talk to your doctor,pharmacist or nurse. This includes any possible side effects not listed in this leaflet.

You can also report side effects directly via the national reporting system listed in Appendix V. By reporting side effects you can help provide more information on the safety of this medicine.

5. How to store Budesonide/Formoterol Teva

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• Keep this medicine out of the sight and reach of children.
• Do not use this medicine after the expiry date which is stated on the carton or on the label of your inhaler after EXP. The expiry date refers to the last day of that month.
• Do not store above 25oC. Keep the mouthpiece cover closed after removal of the foil wrapping.
• Use within 6 months of removing from the foil wrapping. Use the label on the inhaler to write down the opening date of the foil pouch.
• Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. These measures will help protect the environment.

6. Contents of the pack and other information

What Budesonide/For­moterol Teva contains

• – The active substances are budesonide and formoterol fumarate dihydrate. Each delivered (inhaled) dose contains 160 micrograms of budesonide and 4.5 micrograms of formoterol fumarate dihydrate. This is equivalent to a metered dose of 200 micrograms of budesonide and 6 micrograms of formoterol fumarate dihydrate.

• – The other ingredient is lactose monohydrate (see section 2 under ‘Budesonide/For­moterol Teva contains lactose’)

What Budesonide/Formoterol Teva looks like and contents of the pack

- If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet. See section 4.

What is in this leaflet

What Budesonide/For­moterol Teva is and what it is used for (page 3)

What you need to know before you use Budesonide/For­moterol Teva (page 5)

How to use Budesonide/For­moterol Teva (page 8)

Possible side effects (page 16)

How to store Budesonide/For­moterol Teva (page 19)

Contents of the pack and other information (page 19)

What Budesonide/For­moterol Teva is and what it is us

Budesonide belongs to a group of medicines called ‘corticosteroids’ also known as ‘steroids’. It

works by reducing and preventing swe more easily.

Formoterol fumarate dihydrate belongs

agonists’ or ‘bronchodilators’. It works by relaxing the muscles in your airways. This will help to open the airways and help you to breathe more easily.

Budesonide/For­moterol Teva is indicated for use in adults 18 years of age and older only.

Budesonide/For­moterol Teva is NOT indicated for use in children, 12 years of age and younger or adolescents, 13 to 17 years of age.

Your doctor has prescribed this medicine to treat asthma or chronic obstructive pulmonary disease (COPD).

Asthma

When used for asthma, your doctor will prescribe Budesonide/For­moterol Teva together with a separate ‘reliever inhaler’ such as salbutamol.

• Use Budesonide/For­moterol Teva every day. This helps to prevent asthma symptoms such as breathlessness and wheezing from occurring.
• Use the ‘reliever inhaler’ when you get asthma symptoms, to make it easier to breathe again.

Do not use Budesonide/For­moterol Teva 320/9 micrograms as a ‘reliever inhaler’.

Chronic obstructive pulmonary disease (COPD)

COPD is a long-term lung disease of the airways in the lungs, which is often caused by cigarette smoking.

Symptoms include shortness of breath, cough, chest discomfort and coughing up mucus.

Budesonide/For­moterol Teva can also be used to treat the symptoms of severe COPD in adults.

2. What you need to know before you use Budesonide/Formoterol Teva

Do not use Budesonide/For­moterol Teva if:

You are allergic to budesonide, formoterol fumarate dihydrate, or the other ingredient in this medicine (listed in section 6).

Warnings and precautions

Talk to your doctor,pharmacist or nurse before taking Budesonide/For­moterol Teva if

• you are diabetic.
• you have a lung infection.
• you have high blood pressure or you have ever had a heart problem (including an uneven heartbeat, a very fast pulse, narrowing of the arteries or heart failure).
• you have problems with your thyroid or adrenal glands.
• you have low levels of potassium in your blood.
• you have severe liver problems.

If you have been taking steroid tablets for your asthma or COPD, your doctor tablets that you take, once you start to use Budesonide/For­moterol Teva. If yo tablets for a long time, your doctor may want you to have regular blood tests. W you may feel generally unwell even though your chest symptoms may be improving. You might experience symptoms such as a stuffy or runny nose, weakness or joint or muscle pain and rash (eczema). If any of these symptoms bother you, or if symptoms such as headache, tiredness, nausea (feeling sick) or vomiting (being sick) occur, please contact your doctor immediately. You may need to take other medicines if you develop allergic or arthritic symptoms. You should speak to your doctor if you are concerned as to whether you should continue to use Budesonide/For­moterol Teva.

Your doctor may consider adding steroid tablets to your usual treatment during periods of stress (for example, when you have a chest infection or before an operation).

Children and adolescents

This medicine should not be used in children or adolescents under the age of 18 years.

Other medicines and Budesonide/For­moterol Teva

Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines.

In particular, tell your doctor or pharmacist if you are taking any of the following medicines:

• P blockers (such as atenolol or propranolol for high blood pressure or a heart condition), including eyedrops (such as timolol for glaucoma).
• Medicines for a fast or uneven heartbeat (such as quinidine, disopyramide and procainamide).
• Medicines like digoxin, often used to treat heart failure.
• Diuretics, also known as ‘water tablets’ (such as furosemide). These are used to treat high blood pressure.
• Steroid medicines that you take by mouth (such as prednisolone).
• Xanthine medicines (such as theophylline or aminophylline). These are often used to treat asthma.
• Other bronchodilators (such as salbutamol).
• Tricyclic antidepressants (such as amitriptyline) and the antidepressant nefazodone.
• Medicines called monoamine oxidase inhibitors (such as phenelzine, furazolidone and procardazine).
• Phenothiazine medicines (such as chlorpromazine and prochlorperazine).
• Medicines called ‘HIV protease inhibitors’ (such as ritonavir) to treat HIV infection.
• Medicines to treat infections (such as ketoconazole, itraconazole, voriconazole, posaconazole, clarithromycin and telithromycin).
• Medicines for Parkinson’s disease (such as levodopa).
• Medicines for thyroid problems (such as levothyroxine).
• Medicines for allergies or antihistamines (such as terfenadine).

If any of the above applies to you, or if you are not sure, talk to your doctor, pharmacist or nurse before using Budesonide/For­moterol Teva.

Also tell your doctor, pharmacist or nurse if you are going to have a general anaesthetic for an operation or for dental work.

Pregnancy, breast-feeding and fertility

• If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor,pharmacist or nurse for advice before taking Budesonide/For­moterol Teva – do NOT use this medicine unless your doctor tells you to.
• If you get pregnant while using Budesonide/For­moterol Teva, do NOT stop using Budesonide/For­moterol Teva but talk to your doctor immediately.

Driving and using machines

Budesonide/For­moterol Teva is not likely to affect your ability to drive or to use tools or machines.

Budesonide/For­moterol Teva contains lactose

Lactose is a type of sugar found in milk. Lactose contains small amounts of milk protein which may cause allergic reactions.If you have been told by your doctor that you have an intolerance to some sugars, talk to your doctor before using this medicine.

3. How to use Budesonide/Formoterol Teva

Always use this medicine exactly as your doctor or pharmacist has told you. Check with your doctor pharmacist, or nurse if you are not sure.

............. □..............

• It is important to use Budesonide/For­moterol Teva every day, even if you have no asthma or COPD symptoms at the time.
• If you are using Budesonide/For­moterol Teva for asthma, your doctor will want to regularly check your symptoms.

Asthma

Using Budesonide/For­moterol Teva and a separate ‘reliever inhaler’

Use your Budesonide/For­moterol Teva every day. This helps to prevent asthma symptoms from occurring..

kO

Recommended dose:

Adults (18 years and older)

1 inhalation (actuation), twice a day.

Your doctor may increase this to 2 inhalations, twice a day.

If your symptoms are well controlled, your doctor may ask you to take your medicine once a day.

Your doctor will help you to manage your asthma and will adjust the dose of this medicine to the lowest dose that controls your asthma. If your doctor feels that you need a lower dose than is available from your Budesonide/For­moterol Teva, your doctor may prescribe an alternative inhaler containing the same active substances as your Budesonide/For­moterol Teva but with a lower dose of the corticosteroid. However, do not adjust the number of inhalations your doctor has prescribed without talking to your doctor first.

Use your separate ‘reliever inhaler’ to treat asthma symptoms when they happen.

Always keep your ‘reliever inhaler’ with you and use it to relieve sudden attacks of breathlessness and wheezing. Do not use Budesonide/For­moterol Teva to treat these asthma symptoms.

Use of your ‘reliever inhaler’ should not exceed 8 inhalations (puffs) in any 24 hours and you should not use your ‘reliever inhaler’ more often than every 4 hours. If you are regularly using up to 8 inhalations a day or you need to increase the amount of ‘reliever inhaler’ you require, you should see your doctor as soon as possible. Your doctor may need to change your treatment in order to reduce your symptoms of asthma (breathlessness, wheezing and cough) and improve your asthma control and make your breathing easier.

If you are doing exercise and you get asthma symptoms, use your separate ‘reliever inhaler’ to relieve these symptoms. Do not use Budesonide/For­moterol Teva just before exercise to stop asthma symptoms from occurring, use your separate ‘reliever inhaler’.

Chronic Obstructive Pulmonary Disease (COPD)

Recommended dose:

Adults (18 years and older):

• 1 inhalation twice a day.

Your doctor may also prescribe another bronchodilator medicine for example an tiotropium or ipratropium bromide) for your COPD disease.

Preparing your new Budesonide/For­moterol Teva

Before using your Budesonide/For­moterol Teva for the first time , you need to prepare it for use as follows:

Check the dose indicator to see that there are 60 inhalations

Write the date you opened the foil pouch on the label o Do not shake your inhaler before use.

How to take an inhalation

Every time you need to take an inhalation, follow the instructions below.

• 1. Hold your inhaler with the semi-transparent wine red mouthpiece cover at the bottom.

  
  

• 2. Open the mouthpiece cover by folding it down until one loud click is heard. Your medicine is actively metered. Your inhaler is now ready for use.

  3.

  4.

  
  
  
  

Breathe out gently (as far as is comfortable). Do not breathe out through your inhaler.

Place the mouthpiece between your teeth. Do not bite the mouthpiece. Close your lips around the mouthpiece. Take care not to block the air vents.

Breathe in through your mouth as deeply and as hard as you can.

Hold your breath for 10 seconds or as long as you comfortably can.

Remove your inhaler from your mouth. You may notice a taste when you take your inhalation.

Then breathe out gently (do not breathe out through the inhaler). Close the mouthpiece cover.

If you are to take a second inhalation, repeat steps 1 to 7.

Rinse your mouth with water after every dose and spit it out.

Do not try to take your inhaler apart, remove or twist the mouthpiece cover, it is fixed to your inhaler and must not be taken off. Do not use your Spiromax if it has been damaged or if the mouthpiece has come apart from your Spiromax. Do not open and close the mouthpiece cover unless you are about to use your inhaler.

Cleaning your Spiromax

Keep your Spiromax dry and clean.

If necessary you may wipe the mouthpiece of your Spiromax after use with a dry cloth or tissue.

When to start using a new Spiromax

• The dose indicator tells you how many doses (inhalations) are left in your inhaler, starting with 60 inhalations when it is full.

The dose indicator, on the rear of the device, shows

numbers only.

For inhalations remaining from 20 downwards to ‘8’, ‘6’, ‘4’, ‘2’ the numbers are displayed in red on a white background. When the numbers become red in the window, you should consult your doctor and obtain a new inhaler.

Note:

• The mouthpiece will still ‘click’ even when your Spiromax is empty.
• If you open and close the mouthpiece without taking an inhalation, the dose indicator will still register it as a count. This dose will be securely held inside the inhaler for when the next inhalation is due. It is

impossible to accidentally take extra medicine or a double dose in one inhalation.

• Keep the mouthpiece closed all the time unless you are about to use your inhaler.

Important information about your asthma or COPD symptoms

If you feel you are getting breathless or wheezy while using Budesonide/For­moterol Teva, you should continue to use Budesonide/For­moterol Teva but go to see your doctor as soon as possible, as you may need additional treatment.

Contact your doctor immediately if:

• Your breathing is getting worse or you often wake up at night with breathlessness and wheezing.
• Your chest starts to feel tight in the morning or your chest tightness lasts longer than usual.

These signs could mean that your asthma or COPD is not being properly controlled and you may need different or additional treatment immediately.

Once your asthma is well controlled your doctor may consider it appropriate to gradually reduce the dose of Budesonide/For­moterol Teva.

If you use more Budesonide/For­moterol Teva than you should It is important that you take your dose as advised by your doctor. You should not exceed your prescribed dose without seeking medical advice.

If you use more Budesonide/For­moterol Teva than you should, contact your doctor, pharmacist or nurse for advice.

The most common symptoms that may occur after if you use more Budesonide/For­moterol Teva than you should are trembling, headache or a rapid heartbeat.

If you forget to use Budesonide/For­moterol Teva

If you forget to take a dose, take it as soon as you remember. However, do not take a double dose to make up for a forgotten dose. If it is nearly time for your next dose just take your next dose at the usual time.

If you become wheezy or breathless, or develop any other symptoms of an asthma attack, use your ‘reliever inhaler’ , then seek medical advice.

If you stop using Budesonide/For­moterol Teva

Do not stop using your inhaler without telling your doctor first.

If you have any further questions on the use of this medicine, ask your doctor,

4. Possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them.

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If any of the following happen to you, stop using Budesonide/For­moterol Teva and talk to your doctor immediately:

Rare side effects: may affect up to 1 in 1,000 people

• Swelling of your face, particularly around your mouth (tongue and/or throat and/or difficulty to swallow) or hives together with difficulties to breathe (angioedema) and/or sudden feeling of faintness. This may mean that you are having an allergic reaction, which may also include rash and itching.
• Bronchospasm (tightening of the muscles in the airways which causes wheezing and shortness of breath). If the wheezing comes on suddenly after using this medicine stop using it and talk to your doctor immediately.

Very rare side effects: may affect up to 1 in 10,000 people

• Sudden acute wheezing and/or shortness of breath immediately after using your inhaler (also referred to as ‘paradoxical bronchospasm’. If either of these symptoms occur, stop using Budesonide/For­moterol Teva straightaway and use your ’reliever inhaler’ Contact your doctor immediately as you may need to have your treatment changed.

Other possible side effects:

Common: may affect up to 1 in 10 people

• Palpitations (awareness of your heart beating), trembling or shaking. If these effects occur, they are usually mild and usually disappear as you continue to use Budesonide/For­moterol Teva.
• Thrush (a fungal infection) in the mouth. This is less likely to occur if you rinse your mouth out with water after using your medicine.
• Mild sore throat, coughing and a hoarse voice.
• Headache.
• Pneumonia (infection to the lung) in COPD patients.

Tell your doctor if you have any of the following while taking Budesonide/For­moterol Teva they could be symptoms of a lung infection:

• Fever or chills
• Increased mucus production, change in mucus colour
• Increased cough or increased breathing difficulties

Uncommon: may affect up to 1 in 100 people

• Feeling restless, nervous, agitated, anxious or angry.
• Disturbed sleep.
• Feeling dizzy.
• Nausea (feeling sick).
• Fast heartbeat.
• Bruising of the skin.
• Muscle cramps.

Rare:

• Low levels of potassium in your blood.
• Uneven heartbeat.

Very rare:

• Depression.
• Changes in behaviour, especially in children.
• Chest pain or tightness in the chest (angina pectoris).
• Disturbance of the heart’s electrical system (prolongation of the QTc-interval).
• An increase in the amount of sugar (glucose) in your blood.
• Taste changes, such as an unpleasant taste in the mouth.
• Changes in your blood pressure.
• Inhaled corticosteroids can affect the normal production of steroid hormones in your body, particularly

if you use high doses for a long time. The effects include:

• – changes in bone mineral density (thinning of the bones)

• – cataract (clouding of the lens in the eye)

• – glaucoma (increased pressure in the eye)

• – a slowing of the rate of growth of children and adolescents

• – an effect on the adrenal gland (a small gland next to the kidney)

These effects happen very rarely and are much less likely to happen with inhaled corticosteroids than with corticosteroid tablets.

Reporting of side effects

If you get any side effects, talk to your doctor,pharmacist or nurse. This includes any possible side effects not listed in this leaflet.

You can also report side effects directly via the national reporting system listed in Appendix V. By reporting side effects you can help provide more information on the safety of this medicine.

5. How to store Budesonide/Formoterol Teva

• Keep this medicine out of the sight and reach of children.
• Do not use this medicine after the expiry date which is stated on the carton or on the label of your inhaler after EXP. The expiry date refers to the last day of that month.
• Do not store above 25oC. Keep the mouthpiece cover closed after removal of the foil wrapping.
• Use within 6 months of removing from the foil wrapping. Use the label on the inhaler to write down the opening date of the foil pouch.
• Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. These measures will help protect the environment.

6. Contents of the pack and other information

What Budesonide/For­moterol Teva contains

• – The active substances are budesonide and formoterol fumarate dihydrate. Each delivered (inhaled) dose contains 320 micrograms of budesonide and 9 micrograms of formoterol fumarate dihydrate. This is equivalent to a metered dose of 400 micrograms of budesonide and 12 micrograms of formoterol fumarate dihydrate.

What Budesonide/Formoterol Teva looks like and contents of the pack

Budesonide/For­moterol Teva is an inhalation powder.

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This leaflet was last revised in month YYYY.

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Package leaflet: Information for the patient

Budesonide/For­moterol Teva 320 micrograms/9 micrograms, inhalation powder (budesonide/for­moterol fumarate dihydrate)

Read all of this leaflet carefully before you start using this medicine because it contains important information for you.

• – Keep this leaflet. You may need to read it again.

• – If you have any further questions, ask your doctor, pharmacist or nurse.

• – This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if

their signs of illness are the same as yours.

– If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet. See section 4.

What is in this leaflet

What Budesonide/For­moterol Teva is and what it is used for (page 3)

What you need to know before you use Budesonide/For­moterol Teva (page 5)

How to use Budesonide/For­moterol Teva (page 8)

Possible side effects (page 16)

How to store Budesonide/For­moterol Teva (page 19)

Contents of the pack and other information (page 19)

What Budesonide/For­moterol Teva is and what it is us

Budesonide belongs to a group of medicines called ‘corticosteroids’ also known as ‘steroids’. It

works by reducing and preventing swe more easily.

Formoterol fumarate dihydrate belongs

agonists’ or ‘bronchodilators’. It works by relaxing the muscles in your airways. This will help to open the airways and help you to breathe more easily.

Budesonide/For­moterol Teva is indicated for use in adults 18 years of age and older only.

Budesonide/For­moterol Teva is NOT indicated for use in children, 12 years of age and younger or adolescents, 13 to 17 years of age.

Your doctor has prescribed this medicine to treat asthma or chronic obstructive pulmonary disease (COPD).

Asthma

When used for asthma, your doctor will prescribe Budesonide/For­moterol Teva together with a separate ‘reliever inhaler’ such as salbutamol.

• Use Budesonide/For­moterol Teva every day. This helps to prevent asthma symptoms such as breathlessness and wheezing from occurring.
• Use the ‘reliever inhaler’ when you get asthma symptoms, to make it easier to breathe again.

Do not use Budesonide/For­moterol Teva 320/9 micrograms as a ‘reliever inhaler’.

Chronic obstructive pulmonary disease (COPD)

COPD is a long-term lung disease of the airways in the lungs, which is often caused by cigarette smoking.

Symptoms include shortness of breath, cough, chest discomfort and coughing up mucus.

Budesonide/For­moterol Teva can also be used to treat the symptoms of severe COPD in adults.

2. What you need to know before you use Budesonide/For­moterol Teva

Do not use Budesonide/For­moterol Teva if:

You are allergic to budesonide, formoterol fumarate dihydrate, or the other ingredient in this medicine (listed in section 6).

Warnings and precautions

Talk to your doctor,pharmacist or nurse before taking Budesonide/For­moterol Teva if

• you are diabetic.
• you have a lung infection.
• you have high blood pressure or you have ever had a heart problem (including an uneven heartbeat, a very fast pulse, narrowing of the arteries or heart failure).
• you have problems with your thyroid or adrenal glands.
• you have low levels of potassium in your blood.
• you have severe liver problems.

If you have been taking steroid tablets for your asthma or COPD, your doctor tablets that you take, once you start to use Budesonide/For­moterol Teva. If yo tablets for a long time, your doctor may want you to have regular blood tests. W you may feel generally unwell even though your chest symptoms may be improving. You might experience symptoms such as a stuffy or runny nose, weakness or joint or muscle pain and rash (eczema). If any of these symptoms bother you, or if symptoms such as headache, tiredness, nausea (feeling sick) or vomiting (being sick) occur, please contact your doctor immediately. You may need to take other medicines if you develop allergic or arthritic symptoms. You should speak to your doctor if you are concerned as to whether you should continue to use Budesonide/For­moterol Teva.

Your doctor may consider adding steroid tablets to your usual treatment during periods of stress (for example, when you have a chest infection or before an operation).

Children and adolescents

This medicine should not be used in children or adolescents under the age of 18 years.

Other medicines and Budesonide/For­moterol Teva

Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines.

In particular, tell your doctor or pharmacist if you are taking any of the following medicines:

• P blockers (such as atenolol or propranolol for high blood pressure or a heart condition), including eyedrops (such as timolol for glaucoma).
• Medicines for a fast or uneven heartbeat (such as quinidine, disopyramide and procainamide).
• Medicines like digoxin, often used to treat heart failure.
• Diuretics, also known as ‘water tablets’ (such as furosemide). These are used to treat high blood pressure.
• Steroid medicines that you take by mouth (such as prednisolone).
• Xanthine medicines (such as theophylline or aminophylline). These are often used to treat asthma.
• Other bronchodilators (such as salbutamol).
• Tricyclic antidepressants (such as amitriptyline) and the antidepressant nefazodone.
• Medicines called monoamine oxidase inhibitors (such as phenelzine, furazolidone and procardazine).
• Phenothiazine medicines (such as chlorpromazine and prochlorperazine).
• Medicines called ‘HIV protease inhibitors’ (such as ritonavir) to treat HIV infection.
• Medicines to treat infections (such as ketoconazole, itraconazole, voriconazole, posaconazole, clarithromycin and telithromycin).
• Medicines for Parkinson’s disease (such as levodopa).
• Medicines for thyroid problems (such as levothyroxine).
• Medicines for allergies or antihistamines (such as terfenadine).

If any of the above applies to you, or if you are not sure, talk to your doctor, pharmacist or nurse before using Budesonide/For­moterol Teva.

Also tell your doctor, pharmacist or nurse if you are going to have a general anaesthetic for an operation or for dental work.

Pregnancy, breast-feeding and fertility

• If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor,pharmacist or nurse for advice before taking Budesonide/For­moterol Teva – do NOT use this medicine unless your doctor tells you to.
• If you get pregnant while using Budesonide/For­moterol Teva, do NOT stop using Budesonide/For­moterol Teva but talk to your doctor immediately.

Driving and using machines

Budesonide/For­moterol Teva is not likely to affect your ability to drive or to use tools or machines.

Budesonide/For­moterol Teva contains lactose

Lactose is a type of sugar found in milk. Lactose contains small amounts of milk protein which may cause allergic reactions.If you have been told by your doctor that you have an intolerance to some sugars, talk to your doctor before using this medicine.

3. How to use Budesonide/For­moterol Teva

Always use this medicine exactly as your doctor or pharmacist has told you. Check with your doctor pharmacist, or nurse if you are not sure.

............. □..............

• It is important to use Budesonide/For­moterol Teva every day, even if you have no asthma or COPD symptoms at the time.
• If you are using Budesonide/For­moterol Teva for asthma, your doctor will want to regularly check your symptoms.

Asthma

Using Budesonide/For­moterol Teva and a separate ‘reliever inhaler’

Use your Budesonide/For­moterol Teva every day. This helps to prevent asthma symptoms from occurring..

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Recommended dose:

Adults (18 years and older)

1 inhalation (actuation), twice a day.

Your doctor may increase this to 2 inhalations, twice a day.

If your symptoms are well controlled, your doctor may ask you to take your medicine once a day.

Your doctor will help you to manage your asthma and will adjust the dose of this medicine to the lowest dose that controls your asthma. If your doctor feels that you need a lower dose than is available from your Budesonide/For­moterol Teva, your doctor may prescribe an alternative inhaler containing the same active substances as your Budesonide/For­moterol Teva but with a lower dose of the corticosteroid. However, do not adjust the number of inhalations your doctor has prescribed without talking to your doctor first.

Use your separate ‘reliever inhaler’ to treat asthma symptoms when they happen.

Always keep your ‘reliever inhaler’ with you and use it to relieve sudden attacks of breathlessness and wheezing. Do not use Budesonide/For­moterol Teva to treat these asthma symptoms.

Use of your ‘reliever inhaler’ should not exceed 8 inhalations (puffs) in any 24 hours and you should not use your ‘reliever inhaler’ more often than every 4 hours. If you are regularly using up to 8 inhalations a day or you need to increase the amount of ‘reliever inhaler’ you require, you should see your doctor as soon as possible. Your doctor may need to change your treatment in order to reduce your symptoms of asthma (breathlessness, wheezing and cough) and improve your asthma control and make your breathing easier.

If you are doing exercise and you get asthma symptoms, use your separate ‘reliever inhaler’ to relieve these symptoms. Do not use Budesonide/For­moterol Teva just before exercise to stop asthma symptoms from occurring, use your separate ‘reliever inhaler’.

Chronic Obstructive Pulmonary Disease (COPD)

Recommended dose:

Adults (18 years and older):

• 1 inhalation twice a day.

Your doctor may also prescribe another bronchodilator medicine for example an tiotropium or ipratropium bromide) for your COPD disease.

Preparing your new Budesonide/For­moterol Teva

Before using your Budesonide/For­moterol Teva for the first time , you need to prepare it for use as follows:

Check the dose indicator to see that there are 60 inhalations

Write the date you opened the foil pouch on the label o Do not shake your inhaler before use.

How to take an inhalation

Every time you need to take an inhalation, follow the instructions below.

• 1. Hold your inhaler with the semi-transparent wine red mouthpiece cover at the bottom.

  
  

• 2. Open the mouthpiece cover by folding it down until one loud click is heard. Your medicine is actively metered. Your inhaler is now ready for use.

  3.

  4.

  
  
  
  

Breathe out gently (as far as is comfortable). Do not breathe out through your inhaler.

Place the mouthpiece between your teeth. Do not bite the mouthpiece. Close your lips around the mouthpiece. Take care not to block the air vents.

Breathe in through your mouth as deeply and as hard as you can.

Hold your breath for 10 seconds or as long as you comfortably can.

Remove your inhaler from your mouth. You may notice a taste when you take your inhalation.

Then breathe out gently (do not breathe out through the inhaler). Close the mouthpiece cover.

If you are to take a second inhalation, repeat steps 1 to 7.

Rinse your mouth with water after every dose and spit it out.

Do not try to take your inhaler apart, remove or twist the mouthpiece cover, it is fixed to your inhaler and must not be taken off. Do not use your Spiromax if it has been damaged or if the mouthpiece has come apart from your Spiromax. Do not open and close the mouthpiece cover unless you are about to use your inhaler.

Cleaning your Spiromax

Keep your Spiromax dry and clean.

If necessary you may wipe the mouthpiece of your Spiromax after use with a dry cloth or tissue.

When to start using a new Spiromax

• The dose indicator tells you how many doses (inhalations) are left in your inhaler, starting with 60 inhalations when it is full.

The dose indicator, on the rear of the device, shows

numbers only.

For inhalations remaining from 20 downwards to ‘8’, ‘6’, ‘4’, ‘2’ the numbers are displayed in red on a white background. When the numbers become red in the window, you should consult your doctor and obtain a new inhaler.

Note:

• The mouthpiece will still ‘click’ even when your Spiromax is empty.
• If you open and close the mouthpiece without taking an inhalation, the dose indicator will still register it as a count. This dose will be securely held inside the inhaler for when the next inhalation is due. It is

impossible to accidentally take extra medicine or a double dose in one inhalation.

• Keep the mouthpiece closed all the time unless you are about to use your inhaler.

Important information about your asthma or COPD symptoms

If you feel you are getting breathless or wheezy while using Budesonide/For­moterol Teva, you should continue to use Budesonide/For­moterol Teva but go to see your doctor as soon as possible, as you may need additional treatment.

Contact your doctor immediately if:

• Your breathing is getting worse or you often wake up at night with breathlessness and wheezing.
• Your chest starts to feel tight in the morning or your chest tightness lasts longer than usual.

These signs could mean that your asthma or COPD is not being properly controlled and you may need different or additional treatment immediately.

Once your asthma is well controlled your doctor may consider it appropriate to gradually reduce the dose of Budesonide/For­moterol Teva.

If you use more Budesonide/For­moterol Teva than you should It is important that you take your dose as advised by your doctor. You should not exceed your prescribed dose without seeking medical advice.

If you use more Budesonide/For­moterol Teva than you should, contact your doctor, pharmacist or nurse for advice.

The most common symptoms that may occur after if you use more Budesonide/For­moterol Teva than you should are trembling, headache or a rapid heartbeat.

If you forget to use Budesonide/For­moterol Teva

If you forget to take a dose, take it as soon as you remember. However, do not take a double dose to make up for a forgotten dose. If it is nearly time for your next dose just take your next dose at the usual time.

If you become wheezy or breathless, or develop any other symptoms of an asthma attack, use your ‘reliever inhaler’ , then seek medical advice.

If you stop using Budesonide/For­moterol Teva

Do not stop using your inhaler without telling your doctor first.

If you have any further questions on the use of this medicine, ask your doctor,

4. Possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them.

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If any of the following happen to you, stop using Budesonide/For­moterol Teva and talk to your doctor immediately:

Rare side effects: may affect up to 1 in 1,000 people

• Swelling of your face, particularly around your mouth (tongue and/or throat and/or difficulty to swallow) or hives together with difficulties to breathe (angioedema) and/or sudden feeling of faintness. This may mean that you are having an allergic reaction, which may also include rash and itching.
• Bronchospasm (tightening of the muscles in the airways which causes wheezing and shortness of breath). If the wheezing comes on suddenly after using this medicine stop using it and talk to your doctor immediately.

Very rare side effects: may affect up to 1 in 10,000 people

• Sudden acute wheezing and/or shortness of breath immediately after using your inhaler (also referred to as ‘paradoxical bronchospasm’. If either of these symptoms occur, stop using Budesonide/For­moterol Teva straightaway and use your ’reliever inhaler’ Contact your doctor immediately as you may need to have your treatment changed.

Other possible side effects:

Common: may affect up to 1 in 10 people

• Palpitations (awareness of your heart beating), trembling or shaking. If these effects occur, they are usually mild and usually disappear as you continue to use Budesonide/For­moterol Teva.
• Thrush (a fungal infection) in the mouth. This is less likely to occur if you rinse your mouth out with water after using your medicine.
• Mild sore throat, coughing and a hoarse voice.
• Headache.
• Pneumonia (infection to the lung) in COPD patients.

Tell your doctor if you have any of the following while taking Budesonide/For­moterol Teva they could be symptoms of a lung infection:

• Fever or chills
• Increased mucus production, change in mucus colour
• Increased cough or increased breathing difficulties

Uncommon: may affect up to 1 in 100 people

• Feeling restless, nervous, agitated, anxious or angry.
• Disturbed sleep.
• Feeling dizzy.
• Nausea (feeling sick).
• Fast heartbeat.
• Bruising of the skin.
• Muscle cramps.

Rare:

• Low levels of potassium in your blood.
• Uneven heartbeat.

Very rare:

• Depression.
• Changes in behaviour, especially in children.
• Chest pain or tightness in the chest (angina pectoris).
• Disturbance of the heart’s electrical system (prolongation of the QTc-interval).
• An increase in the amount of sugar (glucose) in your blood.
• Taste changes, such as an unpleasant taste in the mouth.
• Changes in your blood pressure.
• Inhaled corticosteroids can affect the normal production of steroid hormones in your body, particularly

if you use high doses for a long time. The effects include:

• – changes in bone mineral density (thinning of the bones)

• – cataract (clouding of the lens in the eye)

• – glaucoma (increased pressure in the eye)

• – a slowing of the rate of growth of children and adolescents

• – an effect on the adrenal gland (a small gland next to the kidney)

These effects happen very rarely and are much less likely to happen with inhaled corticosteroids than with corticosteroid tablets.

Reporting of side effects

If you get any side effects, talk to your doctor,pharmacist or nurse. This includes any possible side effects not listed in this leaflet.

You can also report side effects directly via the national reporting system listed in Appendix V. By reporting side effects you can help provide more information on the safety of this medicine.

5. How to store Budesonide/For­moterol Teva

• Keep this medicine out of the sight and reach of children.
• Do not use this medicine after the expiry date which is stated on the carton or on the label of your inhaler after EXP. The expiry date refers to the last day of that month.
• Do not store above 25oC. Keep the mouthpiece cover closed after removal of the foil wrapping.
• Use within 6 months of removing from the foil wrapping. Use the label on the inhaler to write down the opening date of the foil pouch.
• Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. These measures will help protect the environment.

6. Contents of the pack and other information

What Budesonide/For­moterol Teva contains

• – The active substances are budesonide and formoterol fumarate dihydrate. Each delivered (inhaled) dose contains 320 micrograms of budesonide and 9 micrograms of formoterol fumarate dihydrate. This is equivalent to a metered dose of 400 micrograms of budesonide and 12 micrograms of formoterol fumarate dihydrate.