What is the recommended treatment approach for patients requiring both an oral steroid (corticosteroid) and Symbicort (budesonide/formoterol)?

Treatment Approach for Patients Requiring Both Oral Steroids and Symbicort (Budesonide/Formoterol)

For patients requiring both oral corticosteroids and Symbicort (budesonide/formoterol), oral administration of corticosteroids is recommended over intravenous administration when gastrointestinal access and function are intact, and Symbicort should be continued as maintenance therapy during the oral steroid course. 1

Oral Corticosteroid Administration

When treating patients with conditions requiring both oral steroids and Symbicort:

• Oral corticosteroids are preferred over intravenous administration when the patient can take medications by mouth 1
• This approach offers similar efficacy with potentially fewer adverse effects compared to intravenous administration
• For COPD exacerbations requiring hospitalization, oral corticosteroids have shown equivalent treatment outcomes to intravenous administration for:
  • Treatment failure rates
  • Hospital readmission rates
  • Length of hospital stay 1

Symbicort (Budesonide/Formoterol) Administration

• Continue Symbicort (budesonide/formoterol) maintenance therapy during the oral steroid course 2
• Symbicort combines an inhaled corticosteroid (budesonide) with a long-acting beta2-agonist (formoterol) in a single inhaler 2
• Standard dosing of Symbicort is typically twice daily, with dosage depending on severity of the underlying condition 2, 3
• Do not discontinue Symbicort when initiating oral steroids, as this could lead to worsening of respiratory symptoms 2

Monitoring and Precautions

When using both oral corticosteroids and Symbicort:

• Monitor for increased risk of adverse effects related to corticosteroid use, including:

  • Hyperglycemia
  • Hypertension
  • Adrenal suppression
  • Increased risk of infection 1, 2

• Evaluate patients for lack of symptomatic response to corticosteroid therapy within 2 weeks to determine if therapy modification is needed 1

• For patients with asthma exacerbations, assess response to combined therapy within 8-12 weeks 1

Duration of Therapy

• For acute exacerbations, oral corticosteroids should typically be used for short courses (5-14 days depending on severity) 1
• Taper oral corticosteroids gradually if used for more than 1-2 weeks to avoid adrenal insufficiency 2
• Continue Symbicort as maintenance therapy after completion of the oral steroid course 2, 3

Special Considerations

• For patients with COPD exacerbations, oral corticosteroids are preferred over IV if the patient can take oral medications 1
• For patients with asthma exacerbations, oral corticosteroids are recommended for moderate to severe exacerbations while continuing Symbicort 1
• Avoid abrupt discontinuation of either medication, particularly oral corticosteroids after prolonged use 2

Common Pitfalls to Avoid

1. Abrupt discontinuation of oral steroids: Always taper oral corticosteroids after prolonged use to prevent adrenal crisis
2. Stopping Symbicort during oral steroid therapy: Continue Symbicort as maintenance therapy during and after oral steroid treatment
3. Inadequate monitoring: Watch for steroid-related adverse effects when combining oral and inhaled corticosteroids
4. Prolonged oral steroid use: Aim for the shortest effective duration of oral steroids to minimize adverse effects

Remember that while oral corticosteroids provide systemic anti-inflammatory effects for acute exacerbations, Symbicort provides both local anti-inflammatory effects (budesonide) and bronchodilation (formoterol) for ongoing maintenance therapy of the underlying respiratory condition.