From the Guidelines
Symbicort can be used as both a maintenance and rescue medication in asthma management, an approach known as SMART (Single Maintenance And Reliever Therapy). This approach is supported by recent guidelines, including the 2020 focused updates to the asthma management guidelines 1. The SMART approach involves using the same Symbicort inhaler for daily prevention and for symptom relief when needed, with a standard maintenance dose of 1-2 inhalations twice daily and additional inhalations (up to a maximum of 8 total daily) used as needed for symptom relief.
The benefits of using Symbicort as both a maintenance and rescue medication include reduced severe exacerbations and improved adherence, as patients only need to use one inhaler 1. The formoterol component in Symbicort provides quick relief, while the budesonide component addresses the underlying inflammation with each dose. However, this approach may not be suitable for all patients, particularly those with COPD, and should be implemented under medical supervision with clear instructions on maximum daily doses to avoid potential side effects from overuse.
Key considerations for implementing the SMART approach include:
- Patient age and adherence
- Definition of agents that can be used as reliever therapy
- Escalating asthma therapy in a stepwise approach
- Use of as-needed combination ICS/formoterol or as-needed concomitant short-acting beta2-agonist (SABA) with ICS, which is preferred to or placed on equal footing with SABA alone 1.
Overall, the use of Symbicort as both a maintenance and rescue medication in asthma management can be an effective approach, but it requires careful consideration of individual patient needs and close medical supervision to minimize potential risks and maximize benefits.
From the Research
Symbicort as Maintenance and Rescue
- Symbicort, a combination of budesonide and formoterol, is used for the maintenance and relief of asthma symptoms 2.
- The Global Initiative for Asthma (GINA) recommends single inhaler combination inhaled corticosteroid-formoterol as both maintenance and reliever (SMART) for patients with poorly controlled asthma 2.
- Studies have shown that Symbicort is effective in reducing exacerbations and improving asthma control when used as maintenance and rescue therapy 2, 3.
- A systematic review and meta-analysis found that switching to SMART with Symbicort was associated with a prolonged time to first severe asthma exacerbation compared to stepping up to a higher dose of inhaled corticosteroid-long-acting β2-agonist plus short-acting β2-agonist reliever 2.
- Another study found that budesonide/formoterol combination therapy was more effective than fluticasone/salmeterol in preventing exacerbations in chronic obstructive pulmonary disease (COPD) 4.
Comparison with Other Treatments
- A study comparing Symbicort with fluticasone/salmeterol found that Symbicort was associated with fewer total exacerbations in asthma patients 3.
- A Cochrane review found that fluticasone/salmeterol and budesonide/formoterol had similar effects on lung function outcomes, symptoms, and rescue medication use, but the quality of evidence was moderate to low 5.
- The PATHOS study found that budesonide/formoterol was more effective than fluticasone/salmeterol in reducing exacerbations and healthcare utilization in COPD patients 4.
Key Findings
- Symbicort is an effective maintenance and rescue therapy for asthma and COPD 2, 3, 4.
- SMART with Symbicort may be a preferable treatment option for patients with poorly controlled asthma 2.
- Budesonide/formoterol combination therapy may be more effective than fluticasone/salmeterol in preventing exacerbations in COPD patients 4.