What is the use of Symbicort (budesonide and formoterol)?

From the Guidelines

Symbicort is a recommended medication for the treatment of asthma and chronic obstructive pulmonary disease (COPD), particularly for patients who require a combination of an inhaled corticosteroid and a long-acting beta-agonist. The medication contains two active ingredients: budesonide (an inhaled corticosteroid) and formoterol (a long-acting beta-agonist) 1. For asthma, Symbicort is typically prescribed as 1-2 inhalations twice daily, with common strengths being 80/4.5 mcg or 160/4.5 mcg per inhalation. According to the expert panel report 3 (EPR-3), long-acting beta-agonists (LABAs) such as formoterol are preferred adjunctive therapy to combine with inhaled corticosteroids (ICSs) for long-term control and prevention of symptoms in moderate or severe persistent asthma 1.

The medication works through dual mechanisms: budesonide reduces inflammation in the airways, while formoterol relaxes airway muscles to improve breathing. The combination of ICS and LABA has been shown to reduce the rate of asthma exacerbations, with studies demonstrating that the addition of formoterol to inhaled corticosteroids significantly reduces both mild and severe exacerbations 1. Patients should use Symbicort regularly as prescribed, not just during symptom flare-ups, and rinse their mouth after each use to prevent thrush (fungal infection). Symbicort is not for rescue treatment during acute breathing problems; a separate rescue inhaler should be kept available.

Some key points to consider when prescribing Symbicort include:

• The medication should be used in combination with other treatments, such as short-acting beta-agonists, for acute symptom relief 1.
• Patients should be monitored for side effects, including throat irritation, hoarseness, oral thrush, headache, and tremor.
• The medication typically begins working within minutes, though the full anti-inflammatory benefits may take days to weeks to develop.
• Symbicort is not recommended for monotherapy for long-term control of asthma; instead, it should be used in combination with ICSs for moderate or severe persistent asthma 1.

From the FDA Drug Label

INDICATIONS AND USAGE BUDESONIDE AND FORMOTEROL FUMARATE DIHYDRATE INHALATION AEROSOL is a combination product containing a corticosteroid and a long-acting beta2-adrenergic agonist indicated for: • Treatment of asthma in patients 6 years of age and older. (1.1) • Maintenance treatment of airflow obstruction and reducing exacerbations in patients with chronic obstructive pulmonary disease (COPD) including chronic bronchitis and/or emphysema. (1.2) Important limitations: • Not indicated for the relief of acute bronchospasm. (1.1.2)

The Symbicort inhalation aerosol, which contains budesonide and formoterol, is used for:

• Asthma treatment in patients 6 years and older
• COPD maintenance treatment to reduce exacerbations It is not indicated for relief of acute bronchospasm 2

From the Research

Symbicort Overview

• Symbicort is a combination of a long-acting beta(2)-agonist and inhaled corticosteroid, used for the treatment of asthma and chronic obstructive pulmonary disease (COPD) 3.
• It is available as a maintenance and reliever therapy, allowing patients to use a single inhaler for both maintenance and reliever therapy 3, 4.

Efficacy in Asthma

• Symbicort maintenance and reliever therapy has been shown to reduce the rate of severe asthma exacerbations and maintain day-to-day asthma control at a reduced load of corticosteroids compared to higher fixed maintenance doses of combination inhalers 3.
• Studies have demonstrated a 21-39% reduction in severe exacerbations in patients treated with Symbicort maintenance and reliever therapy compared to traditional combination therapies 4.

Efficacy in COPD

• Symbicort has been compared to other inhaled corticosteroid plus long-acting beta-agonist combinations in patients with COPD, with results suggesting similar efficacy in reducing exacerbations and improving quality of life 5.
• A network meta-analysis found that Symbicort had comparable efficacy to other triple combination therapies in reducing exacerbations and improving lung function and symptoms in patients with moderate to very severe COPD 6, 7.

Safety and Tolerability

• Symbicort has been shown to be well tolerated and safe, with a similar safety profile to other combination therapies 5, 7, 4.
• The use of Symbicort as a maintenance and reliever therapy has been found to be a simplified approach to asthma management, using a single inhaler, which reduces severe exacerbations and maintains similar daily asthma control at a lower drug load compared to traditional strategies 4.