Can a patient with Chronic Obstructive Pulmonary Disease (COPD) be treated with Symbicort (budesonide and formoterol) and oral prednisone?

From the Guidelines

Yes, Symbicort and oral prednisone can be given to someone with COPD, but only under proper medical supervision and with careful consideration of the patient's specific condition and medical history. The use of oral prednisone in COPD exacerbations is supported by the 2017 European Respiratory Society/American Thoracic Society guideline 1 and the 2017 Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy document 1, which recommend a dose of 30-40 mg prednisone per day for 5 days to shorten recovery time, improve lung function, and reduce the risk of early relapse and treatment failure. Some key points to consider when prescribing these medications include:

• The patient's current symptoms and severity of COPD
• The presence of any contraindications or potential interactions with other medications
• The patient's medical history, including any previous experiences with oral corticosteroids
• The potential side effects of these medications, including increased risk of pneumonia, elevated blood pressure, and blood sugar issues. According to the 2017 GOLD executive summary 1, systemic glucocorticoids in COPD exacerbations shorten recovery time and improve FEV1, and a dose of 40 mg prednisone per day for 5 days is recommended. It is essential to note that Symbicort (budesonide/formoterol) is an inhaled corticosteroid and long-acting beta-agonist combination used for maintenance treatment of COPD, while oral prednisone is typically reserved for acute COPD exacerbations. Only a healthcare provider can determine the correct treatment regimen for someone with COPD after a proper medical assessment.

From the FDA Drug Label

Patients requiring oral corticosteroids should be weaned slowly from systemic corticosteroid use after transferring to budesonide and formoterol fumarate dihydrate. Prednisone reduction can be accomplished by reducing the daily prednisone dose by 2. 5 mg on a weekly basis during therapy with budesonide and formoterol fumarate dihydrate. During periods of stress, a severe asthma attack or a severe COPD exacerbation, patients who have been withdrawn from systemic corticosteroids should be instructed to resume oral corticosteroids (in large doses) immediately and to contact their physicians for further instruction

Yes, it is possible to give someone with COPD Symbicort (budesonide and formoterol) and oral prednisone, but patients should be weaned slowly from systemic corticosteroid use after transferring to Symbicort, and prednisone reduction should be done under medical supervision. Patients who have been withdrawn from systemic corticosteroids may need to resume oral corticosteroids during periods of stress or severe COPD exacerbation 2.

From the Research

Treatment of COPD with Symbicort and Oral Prednisone

• The treatment of Chronic Obstructive Pulmonary Disease (COPD) often involves a combination of medications to manage symptoms and prevent exacerbations 3, 4.
• Symbicort, a combination inhaler containing budesonide and formoterol, is one such medication used in the treatment of COPD 4, 5.
• Oral prednisone, a corticosteroid, is also used to treat COPD exacerbations 5.
• A study found that budesonide/formoterol was as effective as prednisolone plus formoterol in treating acute exacerbations of COPD, suggesting that Symbicort could be a viable alternative to oral prednisone in some cases 5.
• However, the decision to use Symbicort and oral prednisone together should be based on individual patient needs and medical history, as there is limited direct evidence on the safety and efficacy of this specific combination 3, 4, 6.

Safety and Efficacy Considerations

• The use of oral corticosteroids, such as prednisone, can have safety implications, including increased risk of side effects with frequent or long-term use 5.
• Inhaled corticosteroids, such as budesonide in Symbicort, may have a more favorable safety profile compared to oral corticosteroids 4, 5.
• The combination of Symbicort and oral prednisone may be considered in patients with severe COPD or those who have not responded to other treatments, but close monitoring and individualized treatment planning are essential 3, 6.

Pharmacoeconomic Considerations

• Symbicort has been shown to be a cost-effective treatment option for COPD, with lower total costs compared to separate inhalers containing budesonide and formoterol 7.
• The use of Symbicort and oral prednisone together may have implications for treatment costs, but further studies are needed to fully evaluate the pharmacoeconomic impact of this combination 7.