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How to use Symbicort SMART®
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| 1. Asthma treatment plan |
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The above is based on the EU SmPc. Labels vary across different countries in the world. Please see national prescribing information for further information regarding dosing instructions.
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| 2. Which inhaler should I prescribe with Symbicort SMART®? |
Two strengths of Symbicort inhaler are appropriate for Symbicort SMART: 160/4.5 mcg/inhalation and 80/4.5 mcg/inhalation. Both have been shown to be effective and safe in clinical trials (Kuna et al 2007; O’Byrne et al 2005; Rabe et al 2006a,b; Vogelmeier et al 2005; Scicchitano et al 2004).
Symbicort 160/4.5 mcg/inhalation is the preferred option for adult patients and this strength can be given as a maintenance dose of 2 inhalations/day, normally 1 inhalation in the evening and 1 inhalation in the morning, with extra inhalations as needed if symptoms occur. For some patients, a higher maintenance dose of 2 inhalations given in the morning and evening may be appropriate.
Symbicort 80/4.5 mcg/inhalation as a maintenance dose of 2 inhalations/day can also be used with Symbicort SMART.
Symbicort 320/9 mcg/inhalation is not approved for use as Symbicort SMART, because the highest strength is not considered appropriate for as needed use in the treatment of asthma.
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3. What should I tell my patients to do if their asthma deteriorates when using Symbicort SMART®?
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Similar to what any asthma patients should do, if they find the treatment ineffective, or exceed the highest recommended dose of treatment, medical attention must be sought. Sudden and progressive deterioration in control of asthma is potentially life-threatening and the patient should undergo urgent medical assessment.
Symbicort SMART allows patients to occasionally take high doses of Symbicort during periods of deteriorating asthma to regain control of their asthma following exposure to unexpected asthma triggers, eg viruses or allergens.
The clinical trial programme has shown that few patients require the use of high doses (more than 8 inhalations/day) over an extended period. However it is advised that patients requiring more than 8 inhalations daily should be recommended to seek medical advice.
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| Note: The above is based on the EU SmPc. Labels vary across different countries in the world. Please see national prescribing information for further information regarding dosing instructions. |
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| A Symbicort SMART treatment plan provided with supporting materials includes guidance to your patients on how they can assess their asthma control, and when they need to seek medical assistance. |
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| 4. Is there a minimum daily dose recommended with Symbicort SMART®? |
Yes, just as with regular maintenance therapy, patients using Symbicort SMART should take their maintenance medication daily, even when asymptomatic.
It is important that patients are educated to take their maintenance medication even when they feel well. Patients should be given a minimum maintenance dose of 2 inhalations/day with additional inhalations as needed if symptoms occur.
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| 5. Is there a maximum daily dose recommended with Symbicort SMART®? |
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A total daily dose of more than 8 inhalations is not normally needed; however, a total daily dose of up to 12 inhalations could be used for a limited period. Patients using more than 8 inhalations daily should be recommended to seek medical advice. They should be reassessed and their maintenance therapy should be reconsidered.
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| 6. Can I allow patients using Symbicort SMART® to also use a separate SABA such as salbutamol for symptom relief? |
No, it is not recommended. If a separate short-acting b-agonist reliever is used, then the full benefits of the Symbicort SMART management approach, i.e. treating inflammation as symptoms occur, are not being maximised.
Patients using salbutamol as their reliever would be simply using Symbicort maintenance therapy, which is less effective than Symbicort SMART.
The Symbicort SMART approach ensures that every inhalation, even inhalations used for relief, treats the underlying inflammation, which increases the treatment effectiveness (Rabe et al 2006a).
Using Symbicort SMART has been shown to significantly reduce severe exacerbations and also hospitalisations and/or emergency room visits compared to fixed Symbicort + SABA as needed (Kuna 2007, Vogelmeier 2005).
Furthermore, Symbicort SMART reduces awakenings due to asthma and daytime symptom score to a significantly greater extent than fixed Symbicort + SABA as needed. (O’Byrne 2005)
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| Symbicort SMART® improves day-to-day control compared to fixed-dose Symbicort + SABA |
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| Reduction in symptoms from run-in |
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| The as-needed inhalations of Symbicort should be taken in response to asthma symptoms but are not intended for regular prophylactic use, eg before exercise. The prophylactic use of Symbicort, eg before exercise, has not been studied. For such use, a separate rapid-acting bronchodilator should be considered. |
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| 7. Can I prescribe Symbicort SMART® to patients with exercise-induced asthma? |
Yes. Both of the monocomponents in Symbicort when taken as maintenance medication have been shown to reduce exercise-induced symptoms. However, the benefit of additional doses of Symbicort before exercise has not been studied.
The reliever inhalations of Symbicort should only be taken in response to asthma symptoms, including exercise-related symptoms, but are not intended for regular prophylactic use before exercise. For such use, a separate rapid-acting bronchodilator should be considered.
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