A smarter way to manage asthma with a combination of a long-acting beta(2)-agonist and inhaled corticosteroid

Abstract

Symbicort SMART(R) (Symbicort Maintenance and Reliever Therapy) represents a new and unique way of treating patients with moderate-to-severe asthma, ie, those patients who require combination treatment with an inhaled corticosteroid and a long-acting inhaled beta(2)-agonist. Symbicort SMART enables patients to use only one inhaler, the budesonide-formoterol combination inhaler, for both maintenance and reliever therapy. The maintenance dose is adjustable, but should be a minimum of two doses per day which can be administered as two doses once daily or as one dose twice daily. It is important that the temporary reliever medication includes not only a bronchodilator but also an antiinflammatory drug because worsening of asthma includes not only more airway narrowing, but also an increase in airway inflammation. The Symbicort SMART concept therefore ensures that the patient gets an antiinflammatory drug at the time of the first signs of asthma worsening. Clinical results show that Symbicort SMART prolongs the time to the first severe asthma exacerbation, reduces the rate of exacerbations, and maintains day-to-day asthma control at a reduced load of corticosteroids (inhaled plus systemic) when compared with higher fixed maintenance doses of combination inhalers. Symbicort SMART consequently offers a more effective and simple approach to asthma management for physicians and patients. Symbicort SMART is also easier for the patient as only one inhaler is required. The positive results with Symbicort SMART can be explained by the early as-needed use on the inhaled corticosteroid component, which puts out the early flames of inflammation, together with the interaction between the beta(2)-agonist, formoterol, and the inhaled corticosteroid, budesonide.

Figure 1

Time to first severe asthma exacerbation. The Symbicort SMART approach resulted in a 45% reduction compared with budesonide-formoterol maintenance therapy with terbutaline as needed, and in a 47% reduction compared with the four times higher dose of budesonide maintenance dose and terbutaline used as needed. American Thoracic Society copyright © 2005. Data reproduced with permission from O’Byrne PM, Bisgaard H, Godard PP, et al. 2005. Budesonide-formoterol combination therapy as both maintenance and reliever medication in asthma. Am J Respir Crit Care Med, 171:129–36. Official journal of the American Thoracic Society. Abbreviations: BUD, budesonide; FORM, formoterol;TERB, terbutaline.

Figure 2

The cumulative rate of severe exacerbations in a study comparing budesonide-formoterol as maintenance and reliever therapy (Symbicort SMART®) compared with salmeterol-fluticasone in adjustable dosing and salbutamol used as needed. Symbicort SMART reduced the exacerbation rate by 22% (p < 0.01). Copyright © 2005. Reproduced with permission from Vogelmeier C, D’Urzo A, Pauwels R, et al. 2005. Budesonide-formoterol maintenance and reliever therapy: an effective asthma treatment option? Eur Respir J, 26:819–28. Abbreviations: BUD/FORM, budesonide-formoterol; SAL/FP, salmeterol-fluticasone.

Figure 3

Time to the first severe asthma exacerbation. All patients used similar doses of budesonide-formoterol, as maintenance therapy. The as-needed medication was budesonide-formoterol (Symbicort SMART), formoterol or terbutaline. The risk of having a severe exacerbation was reduced by 27% with Symbicort SMART compared with formoterol and by 45% compared with terbutaline as as-needed medication. Copyright © 2006. Reproduced with permission from Rabe KF, Atienza T, Magyar P, et al. 2006. Effect of budesonide in combination with formoterol for reliever therapy in asthma exacerbations: a randomised controlled, double-blind study. Lancet, 368:744–53. Abbreviations: BUD/FORM, budesonide-formoterol; FORM, formoterol;TERB, terbutaline.

Figure 4

Interaction between budesonide and the long-acting β₂-agonists (LABA) formoterol. Budesonide has antiinflammatory effects but also increases the numbers of β₂-receptors, whereas formoterol, as well as inducing direct bronchodilation, acts on glucocorticoid receptors (GR) to increase the antiinflammatory effects of budesonide and increases the translocation of budesonide into the cell nucleus. Copyright © 2002. Modified with permission from Barnes PJ. 2002. Scientific rationale for inhaled combination therapy with long-acting β₂-agonists and corticosteroids. Eur Respir J, 19:182–91. Abbreviations: GRE, glucocorticoid response element.