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Why can Symbicort® be used as maintenance and reliever therapy?
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| 1. Why can Symbicort® be used as maintenance and reliever therapy? |
With Symbicort, patients take a regular dose consisting of the ICS budesonide and the LABA formoterol, and additional inhalations of Symbicort if needed to provide symptom relief and simultaneously improve control.
When additional inhalations are required, Symbicort allows an increased dose of both components thereby addressing the underlying inflammation as well as offering effective symptom relief.
Symbicort has shown to be as effective as salbutamol in relieving severe bronchoconstriction.(Balanag et al 2006).
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Increasing both the dose and the frequency of budesonide administration is beneficial in asthma that is poorly controlled (Toogood et al 1982).
It has also been shown that temporarily increasing the dose of budesonide at the first sign of worsening asthma effectively manages an exacerbation as well as regular higher doses of budesonide (Foresi et al 2000).
This study showed that once asthma was under control, a low dose of budesonide was as effective as a fixed moderate dose for maintaining asthma control, provided this dose was increased (both total dose and frequency) at the first sign of a worsening in asthma control.
In addition to the maintenance doses taken for day-to-day asthma control, Symbicort is also used as needed if symptoms occur, to provide both rapid relief and increased asthma control.
Clinical studies show that patients using Symbicort SMART experience fewer daily symptoms, experience less night-time awakenings and have fewer severe exacerbations compared with ‘traditional’ fixed-dose ICS/LABA therapy plus as needed SABA (O’Byrne et al 2005; Rabe et al 2006).
The reduction in exacerbations seen with Symbicort SMART suggests that a crucial factor might be related to the timing of the budesonide dose. Lung tissue concentrations decline between maintenance doses (Miller-Larsson 1998,Jendbro 2001). Therefore, budesonide taken as needed might supplement the tissue concentrations at a time when the concentration is suboptimal.
Symbicort SMART aims to provide a dose of medication that is appropriate to the level of inflammation, treating the underlying inflammation with every inhalation.
Furthermore, increasing the dose of budesonide and formoterol at the first sign of asthma symptoms may prevent the development into exacerbations.
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| 2. Can other combination therapy inhalers be used as both maintenance and reliever therapy? |
Due to its unique properties, Symbicort is the only inhaled corticosteroid/b2-agonist combination that is approved to be used as maintenance and relief in one inhaler. This is because both the inhaled corticosteroid budesonide and the b2-agonist formoterol show a clear dose response (i.e. higher doses have a greater effect).
This approach is not possible with a combination product containing the other long-acting b2-agonist salmeterol (such as Seretide), due to the lack of dose response for salmeterol.
In addition, Symbicort has a faster onset of effect than Seretide (Palmqvist et al 2001). Symbicort has a rapid onset of effect comparable with traditional relievers such as salbutamol (Balanag et al 2003).
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Palmqvist et al 2001
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| 3. Is the onset of Symbicort® as fast as that of SABA? |
Yes. Studies performed in both stable and acute severe asthma confirm that the formoterol component of Symbicort works as fast as salbutamol or terbutaline (Boonsawat et al 2003; Seberova et al 2000). The onset of effect of Symbicort was found to be as rapid as that of salbutamol (Balanag et al 2006).
In this study, Symbicort was well-tolerated and was not associated with any increase in adverse effects compared with salbutamol. Patients confirmed that they felt relief from breathlessness within the first minute of taking Symbicort (van de Woude et al 2004).
This is due to the unique profile of the formoterol component, which, in addition to long-acting bronchodilation, has a rapid onset of action.
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| Symbicort®: onset of effect similar to salbutamol |
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| 4. Does Symbicort® have a faster onset of effect than Seretide™? |
Yes, Symbicort has a faster onset of effect than Seretide (Palmqvist et al 2001). Symbicort has a rapid onset of effect comparable with traditional relievers such as salbutamol (Balanag et al 2003).
The faster onset of effect of Symbicort compared with Seretide was confirmed in a double-blind, placebo-controlled trial involving 30 patients with asthma and reversible airflow obstruction (mean forced expiratory volume in 1 second [FEV1] 78% of predicted normal, mean reversibility after 500 µg salbutamol 19%, Palmqvist et al 2001) in which the onset of effect was measured by FEV1 at 3 minutes and average FEV1 from 0–15 minutes.
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| Symbicort® has a faster onset of effect than Seretide™ |
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| The rapid onset of effect of Symbicort means that patients feel the benefit of Symbicort very quickly. |
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| 5. How can Symbicort SMART® improve asthma control and reduce the dose at the same time? |
The increased efficacy of Symbicort SMART is achieved with an increase in dose of therapy at the right time to prevent asthma worsening and exacerbations rather than sustaining a higher dose continuously.
On 56% of the days no reliever therapy is needed with Symbicort SMART, hence on these symptom-free days patients receive 50% less Symbicort than would be taken with a fixed higher dose Symbicort regimen (Kuna et al 2007).
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| No increased drugload when using Symbicort SMART® |
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| 6. Can Symbicort® really replace the use of a SABA? |
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Symbicort works as fast and is as effective as salbutamol (Balanag et al 2006). With Symbicort SMART, anti-inflammatory therapy is provided with every inhalation, both as maintenance and relief. This is not achieved when using a traditional fixed dosing treatment with a separate as needed SABA.
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| Symbicort®: onset of effect similar to salbutamol |
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