| 1. Why is adjustable
dosing so important in treating asthma? |
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Asthma is a highly variable disease marked with chronic inflammation
of varying severity. Worsenings and exacerbations of asthma are
associated with episodes of acute inflammation, which develop
on top of persistent underlying chronic inflammation. This acute
inflammation causes an increase in symptoms and may also lead
to an increased sensitivity to triggers and a worsening in airway
hyperresponsiveness.
The variability and severity of ‘real life’ asthma is
dependent on a number of factors, including a patient’s adherence
to the prescribed treatment. This means that optimal asthma therapy
must be adjustable, with dose and dose frequency being altered
in response to changing symptom patterns.
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| 2. Can I step up and step
down the Symbicort dose using the same single inhaler? |
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| Symbicort offers the unique opportunity to step up
and step down the dose, allowing you to tailor the medication plan
to the needs and circumstances of the individual patient without
the need to switch or add other inhalers. The dual action of Symbicort
is based on budesonide and formoterol – two components with
documented dose-response profiles (Busse et al, 1998; Schreurs et
al, 1996; Kemp et al, 1997) and good tolerability (Ankerst et al,
2001).
The possibility of switching between one and two daily inhalations,
and between once- and twice-daily administration, means that Symbicort
provides unparalleled dosing versatility with the same single
inhaler.
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| 3. Why can Symbicort be used
in such an adjustable manner? |
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| Symbicort delivers both budesonide and formoterol, two asthma
drugs with proven efficacy and unique pharmacologic properties.
Both drugs demonstrate clear dose-response profiles. This provides
the versatility in dosing that is unique to Symbicort.
Budesonide
Dose-response studies have shown that even low doses of inhaled
budesonide significantly improve lung function and reduce exacerbations
compared with placebo and produces further dose-dependent improvements
in lung function at doses up to 800mg twice daily (Busse, 1998).
In addition, budesonide, in contrast to other corticosteroids
such as fluticasone propionate and beclomethasone, forms intracellular
esters that remain as drug reservoirs in the local airways and
which are gradually released over time (Miller-Larsson, 1998;
Miller-Larsson, 2000). This unique characteristic may partially
explain why it is possible to dose budesonide once daily. Improvement
in morning PEF in patients receiving budesonide ranging from 100-800mg
twice daily.
Formoterol
When the regular dose of formoterol is increased in asthmatic
patients, clinical response improves (Kemp J, et al 1997 and Ketchell
RI, et al 2002).
Increasing formoterol dose increases clinical response
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| 4. Adjustable
maintenance dosing with Symbicort |
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| Using Symbicort® in an adjustable maintenance dosing regimen
could avoid over- and undertreatment and instead aims to provide
patients with the right level of medication at the right time. Increasing
the dose of both components of Symbicort when symptoms worsen may
enable asthma control to be more quickly regained, while providing
the patient with rapid relief from symptoms. This treatment concept
is unique to Symbicort and is possible because of the dose-response
to both budesonide and formoterol.
Versatile dosing is unique to Symbicort® as both the budesonide
and formoterol components are being dosed such that there are
additional benefits to increasing the dose. It means that patients
can dose up and down the dose-response curve to better control
the varying symptoms by simply increasing or decreasing the number
of inhalations using the same, single inhaler. This is in contrast
to Seretide where you would have to prescribe a new inhaler with
a different strength when adjusting the dose as the LABA component
of Seretide, salmeterol, is showing no additional benefits when
increasing the dose.
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| 5. Is Symbicort®
adjustable maintenance dosing better than fixed dosing? |
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The two different treatment philosophies have been compared in
studies. Adjustable and fixed dosing with Symbicort® were compared
in a study with 1034 asthmatic patients (Stallberg et al, 2003).
The study results show that Symbicort® adjustable maintenance
dosing:
- Offers patients superior asthma control, at a lower overall drug
load, compared with fixed-dosing combination regimens
- Is more effective at reducing asthma exacerbations than fixed
dosing
Symbicort adjustable maintenance dosing has also been compared
with Seretideä fixed dosing. A study with 658 asthmatic patients
compared Symbicort® adjustable maintenance dosing with Symbicort®
and Seretideä fixed dosing (Aalbers et al, 2003).
Conclusions from the study:
- Symbicort adjustable maintenance dosing provides superior asthma
control compared to Seretide and Symbicort fixed dosing.
- Symbicort adjustable maintenance dosing had a 40% lower exacerbation
rate and lower use of reliever medication for symptom control
than Seretide fixed dosing
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