Pulmicort as part of Symbicort®

What is Symbicort?" ] 
Pulmicort vs. Symbicort in asthma" ] 
Pulmicort vs. Symbicort in COPD" ] 

What is Symbicort®?

Symbicort® is a combination product delivering through the dry powder inhaler, Turbuhaler®, the inhaled corticosteroid, budesonide, together with the rapid- and long-acting ß₂ -agonist bronchodilator, formoterol. One dose of Symbicort contains 80 or 160 µg budesonide together with 4.5 µg formoterol, or 320 µg budesonide with 9 µg formoterol. These doses are labelled as delivered doses leaving the inhaler (not doses metered in the inhaler as is the case for Pulmicort Turbuhaler).

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Pulmicort vs. Symbicort in asthma

Efficacy of budesonide (Pulmicort) has been evaluated in comparison with budesonide plus formoterol delivered via two inhalers in patients with mild persistent asthma (OPTIMA)(1) and moderate persistent asthma (FACET) (2). These studies showed that patients with mild persistent asthma not previously treated with inhaled corticosteroids benefited significantly from Pulmicort alone, whereas patients not well controlled in their asthma and already using inhaled corticosteroids improved significantly when formoterol was added.

Clinical studies with the combination product (Symbicort) vs. Pulmicort alone have shown a similar pattern (3-5).

Morning PEF in a study comparing budesonide and formoterol administered via one or two inhalers 

Morning PEF in 362 patients with moderate-to-severe asthma treated for 12 weeks with two inhalations of Symbicort 160/4.5 µg twice daily. Pulmicort Turbuhaler 200 µg twice daily plus Oxis Turbuhaler 4.5 µg twice daily. Combination treatment with Pulmicort and Oxis produced significantly greater increases in PEF than Pulmicort alone; the effect of Symbicort tended to be faster than that of Pulmicort and Oxis given via separate inhalers.

Reference:
1. O´Byrne et al.: Low dose inhaled budesonide and formoterol in mild persistent asthma. Am J Respir Crit Care Med 2001; 164: 1392-1397.

2. Pauwels RA et al.: Effect of inhaled formoterol and budesonide on exacerbations of asthma. N Engl J Med 1997; 337: 1405-1411.

3. Zetterström O et al.: Improved asthma control with budesonide/formoterol in a single inhaler, compared with budesonide alone. Eur Respir J 2001; 18: 1-7.

4. Tal A et al. Budesonide/formoterol in a single inhaler versus inhaled corticosteroids alone in the treatment of asthma. Ped Pulmonol 2002; 34: 342-350.

5. Kuna P, Kuprys I. Symbicort Turbuhaler: a new concept in asthma management. Int J Clin Pract 2002; 56: 797-803.

6. Buhl R. Budesonide/formoterol for the treatment of asthma. Expert Opin Pharmacother 2003; 4 (8): 1393-1406. 

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Pulmicort vs. Symbicort in COPD

Two placebo-controlled clinical studies in patients with moderate-to-severe COPD comparing the monocomponents (budesonide; formoterol) with Symbicort have shown Symbicort treatment to result in fewer severe exacerbations, less symptoms and use of rescue medication, better lung function and quality of life (1,2).

Treatment with Pulmicort alone also resulted in statistically significant reductions of severe exacerbations and improvements in symptoms and quality of life, but not in airway function.

Exacerbation rates in patients with moderate-to-severe COPD treated with Symbicort (budesonide/formoterol), the monocomponents or placebo 

The absolute number of severe exacerbations in the two studies (1,2) was significantly reduced by Symbicort treatment. The beneficial effect on exacerbations is not due to the bronchodilatory component of Symbicort, and it is also larger than the steroid effect alone.

Reference:
1. Szafranski W et al.: Efficacy and safety of budesonide/formoterol in the management of chronic obstructive pulmonary disease. Eur Respir J 2003; 21: 74-81.

2. Calverley PM, et al. Maintenance therapy with budesonide and formoterol in chronic obstructive pulmonary disease. Eur Respir J 2003; 22 (6): 912-9.

 Symbicort
 Pulmicort in COPD  

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