Can you use Symbicort (budesonide and formoterol) and Airsupra (fluticasone and vilanterol) together?

Concurrent Use of Symbicort and Airsupra in Asthma Management

Symbicort (budesonide/formoterol) and Airsupra (albuterol/budesonide) should not be used together as they contain overlapping medications that could lead to overdosage of inhaled corticosteroids and increased risk of adverse effects.

Understanding the Medications

Symbicort

• Contains budesonide (inhaled corticosteroid) and formoterol (long-acting beta2-agonist or LABA) 1, 2
• Used as maintenance therapy for persistent asthma 3
• Provides both anti-inflammatory effects (budesonide) and long-term bronchodilation (formoterol) 2
• Typically dosed twice daily for asthma control 4

Airsupra

Note: There appears to be confusion in the question. Airsupra contains albuterol/budesonide, not fluticasone/vilanterol (which is Breo Ellipta). I will address both possibilities:

If Airsupra (albuterol/budesonide):

• Contains budesonide (same corticosteroid as in Symbicort) and albuterol (short-acting beta2-agonist)
• Using both medications would result in duplicate budesonide therapy, risking overdosage 5

If referring to Breo Ellipta (fluticasone/vilanterol):

• Contains fluticasone (different corticosteroid) and vilanterol (LABA) 5
• Using both would mean concurrent therapy with two different LABAs (formoterol and vilanterol), which is not recommended 5

Risks of Concurrent Use

Overlapping Corticosteroid Therapy

• Increased risk of corticosteroid-related adverse effects 5
• Potential side effects include oral thrush, dysphonia, adrenal suppression, and in high doses, systemic effects 5

Overlapping LABA Therapy (if using with Breo Ellipta)

• Increased risk of cardiovascular effects such as tachycardia, palpitations, and hypertension 5
• Safety concerns with LABAs include potential for severe exacerbations and increased mortality risk when used inappropriately 5

Appropriate Asthma Management Approach

For Persistent Asthma

• Step-up therapy should follow guideline-recommended approaches 5
• If Symbicort (medium-dose inhaled corticosteroid plus LABA) is insufficient:
  • Consider increasing to high-dose inhaled corticosteroid plus LABA 5
  • Consider adding a third controller medication (such as a leukotriene receptor antagonist) 5
  • For severe allergic asthma, consider adding omalizumab 5

For Rescue Therapy

• Patients on Symbicort should use a separate short-acting beta2-agonist (SABA) like albuterol alone (not Airsupra) for rescue therapy 5
• Some patients may be candidates for the Symbicort SMART approach (using the same inhaler for both maintenance and rescue), but this should be specifically prescribed 6

Common Pitfalls to Avoid

• Using multiple medications containing the same active ingredients, risking overdosage 5
• Combining multiple LABAs, which increases risk of adverse effects without additional benefit 5
• Focusing only on bronchodilation without addressing underlying inflammation 2
• Poor adherence to maintenance therapy, leading to overreliance on rescue medications 3

Alternative Approaches

• If current therapy is inadequate, consider stepping up within a single combination product rather than adding a second combination 5
• For patients requiring both ICS and LABA therapy, using a single combination inhaler improves adherence compared to separate inhalers 4
• Consider adjustable maintenance dosing with budesonide/formoterol, which allows dose adjustment based on symptom control 4

Remember that any changes to asthma medication regimens should be done under medical supervision to ensure appropriate dosing and monitoring for adverse effects.