What is the role of AISupra and Symbicort (budesonide and formoterol) in an asthma regimen?

From the Guidelines

AISupra is not a recognized asthma medication, while Symbicort (budesonide and formoterol) is a crucial combination inhaler for asthma management, serving as both a controller and reliever medication. Symbicort combines budesonide, an inhaled corticosteroid that reduces airway inflammation, with formoterol, a long-acting beta-agonist (LABA) that provides bronchodilation. According to the most recent guidelines, such as those outlined in the 2020 focused updates to the asthma management guidelines 1 and the 2021 update on the NIH asthma management guidelines 1, Symbicort is typically prescribed for patients with moderate to severe persistent asthma who require both anti-inflammatory and bronchodilator therapy.

Key Points for Symbicort Use:

• The standard dosing is usually 1-2 inhalations twice daily, though this can vary based on asthma severity and patient response.
• Some patients may use Symbicort in a maintenance and reliever therapy (MART) approach, where the same inhaler serves as both daily controller and as-needed rescue medication.
• Symbicort should be used regularly as prescribed, even when symptoms are absent, to maintain asthma control.
• Patients should rinse their mouth after use to prevent oral thrush, a potential side effect of the inhaled corticosteroid component.
• The combination of these medications works synergistically - the corticosteroid reduces inflammation while the LABA keeps airways open, providing better asthma control than either medication alone, as supported by studies such as those referenced in 1 and 1.

Recommendations:

• For individuals aged 12 years and older with moderate to severe persistent asthma, the expert panel conditionally recommends ICS-formoterol in a single inhaler used as both daily controller and reliever therapy, as opposed to higher-dose ICS-LABA as daily controller therapy and SABA for quick-relief therapy 1.
• The use of Symbicort aligns with the principle of using combination therapy for better control of asthma symptoms and prevention of exacerbations, as highlighted in guidelines and studies 1.

Given the evidence, the use of Symbicort (budesonide and formoterol) is recommended for patients with moderate to severe persistent asthma, as it provides effective control of symptoms and reduces the risk of exacerbations, thereby improving morbidity, mortality, and quality of life outcomes.

From the FDA Drug Label

Budesonide inhalation suspension is a long-term maintenance medicine used to control and prevent asthma symptoms in children ages 12 months to 8 years. Inhaled corticosteroids help to decrease inflammation in the lungs. Budesonide inhalation suspension helps reduce swelling and inflammation in the lungs, and helps keep the airways open to reduce asthma symptoms.

The role of AISupra (budesonide) and Symbicort (budesonide and formoterol) in an asthma regimen is to control and prevent asthma symptoms by reducing inflammation in the lungs.

• Budesonide is an inhaled corticosteroid that helps decrease inflammation in the lungs.
• Symbicort is a combination of budesonide (an inhaled corticosteroid) and formoterol (a long-acting beta2-agonist) that helps control asthma symptoms by reducing inflammation and keeping the airways open. It is essential to use these medications exactly as prescribed by a healthcare provider and to have a short-acting beta2-agonist medicine (rescue inhaler) available to treat sudden asthma symptoms 2.

From the Research

Role of AISupra and Symbicort in Asthma Regimen

• AISupra is not mentioned in the provided studies, therefore, its role in an asthma regimen cannot be determined from the given evidence.
• Symbicort, a combination of budesonide and formoterol, plays a significant role in asthma management as it combines an inhaled corticosteroid with a long-acting beta2-agonist in a single inhaler 3, 4, 5, 6, 7.

Mechanism of Action

• Budesonide, the inhaled corticosteroid component, reduces airway inflammation and bronchial hyper-responsiveness in asthma 3.
• Formoterol, the long-acting beta2-agonist component, prevents and reverses airway obstruction, providing rapid and sustained bronchodilation 4, 5.

Efficacy and Safety

• Studies have shown that Symbicort is more effective than double-dose corticosteroid therapy and at least as effective as budesonide and formoterol given in separate inhalers 3, 4, 5.
• Symbicort has a fast onset of effect and a long duration of action, allowing for twice-daily or once-daily dosing, which can improve patient adherence to treatment 4, 5, 7.
• The combination of budesonide and formoterol in Symbicort has been shown to reduce exacerbations and hospitalizations compared to other treatments, with a lower overall drug load 6, 7.

Dosage and Administration

• Symbicort can be administered once or twice daily, with adjustable maintenance dosing providing equivalent or better asthma control with a significantly lower amount of study drug use compared to fixed dosing 5, 7.
• The Symbicort maintenance and reliever therapy (SMART) dosing regimen, which uses Symbicort as both a maintenance and reliever medication, has been shown to reduce exacerbations and reliever medication use compared to fixed-dosing regimens 6, 7.