Budesonide/formoterol pressurized metered-dose inhaler: a guide to its use in asthma
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Budesonide/formoterol pressurized metered-dose inhaler: a guide to its use in asthma The corticosteroid budesonide and the long-acting β2-adrenoceptor agonist formoterol have been combined into a single pressurized metered-dose inhaler (pMDI). The combination pMDI improves lung function, asthma control, asthma symptoms and asthma-related quality of life outcomes in patients with persistent asthma that is mild to moderate or moderate to severe. Adapted from Drugs 2008; 68 (13): 1865-64.[1]
What is the rationale for combining the drugs in one inhaler? Asthma, a common chronic respiratory disease, is characterized by chronic inflammation and hyperresponsiveness of the airways.[2] Management of asthma aims to achieve and maintain control of the characteristic symptoms of asthma (i.e. wheeze, breathlessness, chest tightness and cough) for prolonged periods.[2] Current US asthma guidelines for the treatment of adolescents aged ≥12 years and adults with persistent asthma use a stepwise approach to asthma control (Patient care guidelines).[2] Treatment with an inhaled corticosteroid (ICS) plus an inhaled long-acting β2adrenoceptor agonist (LABA) is the preferred strategy in patients with persistent asthma that is not adequately controlled by maintenance therapy with a low to moderate dose of ICS alone (Patient care guidelines).[2] The addition of an LABA to an ICS regimen improves lung function and asthma symptoms, and decreases the asrequired use of quick-relief medications (i.e. short-acting inhaled β2-adrenoceptor agonists).[2] This treatment strategy has lead to the development of inhalers containing a corticosteroid and LABA in one device. Administration of both agents via one inhaler is convenient, simplifies administration, may have beneficial effects on treatment compliance, and prevents patients from selectively choosing to stop the use of one of the medications. In the US, the combination of the corticosteroid budesonide plus the LABA formoterol fumarate dihydrate (formoterol) is available for administration via one hydrofluoroalkane-propelled pressurized metered-dose inhaler (pMDI),[3] hereafter referred to as budesonide/ formoterol pMDI (Symbicort®).
How do the two drugs work? Budesonide and formoterol target different aspects of asthma pathology.[4] Budesonide has potent antiinflammatory activity, particularly on epithelial cells in the airways. Formoterol, a potent, selective β2-adrenoceptor agonist, provides rapid and long-lasting bronchodilatory activity. When administered together, the effects of the two agents are complementary and additive.[4] Budesonide/formoterol pMDI provides a rapid bronchodilatory response in patients with asthma.[1] Its onset of action was significantly faster than that of salmeterol/fluticasone dry powder inhaler (DPI) or placebo
Step 1 Inhaled short-acting β2-adrenoceptor agonist as required for symptom relief (use at each treatment step depending on severity of symptoms)
Step 2 Low-dose inhaled corticosteroid (ICS)
Step 3 Low-dose ICS plus inhaled long-acting β2-adrenocepto
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