Asthma and chronic obstructive pulmonary disease (COPD) are highly prevalent in chronic respiratory diseases and leading causes of morbidity and mortality worldwide. Asthma-COPD overlap (ACO) is a challenging phenotype of obstructive airway disease where patients have clinical features of both asthma and COPD.
Inhaled therapy is recommended as the primary route of administration for medication used to manage asthma and COPD. An additive effect in alleviating asthma symptoms has been demonstrated with combination therapy of budesonide (an inhaled corticosteroid (ICS)) and formoterol fumarate [a long-acting β2-adrenergic agonist (LABA)] (budesonide/formoterol).
Many types of devices for delivery of inhaled drugs are available. For patients who may find it difficult to use an inhaler (e.g. older patients with arthritis or weakness or people with disabilities), check the following to work out which inhaler type will be easiest to use.
What is Symbicort?
Symbicort is a combination inhaled corticosteroid (ICS) and long-acting beta2 agonist (LABA) inhaler used in asthma and COPD. It contains budesonide and formoterol.
Symbicort is currently approved for marketing as a dry-powder inhaler (DPI, Turbuhaler) and a pressurized metered-dose inhaler (MDI, Rapihaler, Vannair).
- Symbicort® Turbuhaler® 100mcg/6mcg, Inhalation powder
- Symbicort® Turbuhaler® 200mcg/6mcg, Inhalation powder
- Symbicort® Turbuhaler® 400mcg/12mcg, Inhalation powder
Symbicort Turbuhaler, all strengths, can be used as regular Maintenance Therapy in adults, and adolescents 12 years and older, and children aged 6 years and older (100/6 only).
Symbicort Turbuhaler 200/6 and 100/6 can also be used for Symbicort Reliever Therapy in adults and adolescents 12 years and older.
Symbicort Rapihaler Vs Symbicort Turbuhaler
Symbicort Rapihaler is a 2-actuation product i.e. in order to ensure dose uniformity, each dosing occasion is always to consist of multiples of 2 actuations. The Symbicort Rapihaler MDI and Symbicort Turbuhaler DPI range are aligned to provide equivalent daily doses:
- two inhalations of the Rapihaler 50/3 will provide a therapeutically equivalent dose to one inhalation of the Turbuhaler 100/6 presentation and
- two inhalations of the Rapihaler 100/3 will provide a therapeutically equivalent dose to one inhalation of the Turbuhaler 200/6 presentation and
- two inhalations of the Rapihaler 200/6 will provide a therapeutically equivalent dose to one inhalation of the Turbuhaler 400/12 presentation
Teva UK Limited has now launched a combination budesonide/formoterol inhaler called DuoResp Spiromax®, which has just been added to the Dorset Formulary.
Symbicort Turbuhaler Vs DuoResp Spiromax
There are important differences between Symbicort Turbuhaler® and DuoResp Spiromax®:
- Symbicort Turbuhaler® 200/6 and 400/12 can be used as maintenance therapy from 12 years of age, whereas DuoResp Spiromax® is only licensed from 18 years of age, so prescribing generically would mean an adolescent patient is potentially provided with a DuoResp Spiromax® inhaler which is not licensed in their age group.
- Although Symbicort Turbuhaler® and DuoResp Spiromax® are both breath actuated inhalers, they are both activated differently, and require totally different inhaler techniques.
- If the patient receives an inhaler different to the one, they normally use, they may not have been trained in the use of the device and may not have the correct inhaler technique, with implications for asthma and COPD control.
This table summarizes the characteristics of various devices
Choosing an inhaler device to suit the individual
The main types of inhaler devices for asthma and COPD medicines are:
Manually-actuated pressurized metered-dose inhalers (conventional puffer)
- e.g. Rapihaler, various generic names such as inhaler, CFC-free inhaler and metered aerosol.
Breath-actuated pressurized metered-dose inhalers
- e.g. Autohaler
Dry powder inhalers (multi-dose)
- e.g. Accuhaler, Ellipta, Genuair, DuoResp Spiromax, Turbuhaler
Dry powder inhalers (capsule)
- e.g. Breezhaler, Handihaler
- e.g. Respimat
The correct inhaler technique depends on the device. Poor inhaler technique is extremely common and is associated with worse outcomes in asthma and COPD, including poor asthma symptom control and overuse of reliever and preventer medications.
Regardless of the type of inhaler device prescribed, all patients need training in correct inhaler technique, including a physical demonstration. As inhaler technique worsens over time, all patients need regular checking to ensure they are using their inhalers correctly.
If you have questions about your prescription medications or any other medication, please contact our team at CheapoMeds by calling toll free 1-844-4CHEAPO (424-3276). One of our patient representatives will be happy to assist you or transfer you to a licensed Canadian pharmacist for a free consultation.
This article contains medical information provided to help you better understand this particular medical condition or process and may contain information about medication often used as part of a treatment plan prescribed by a doctor. It is not intended to be used as either a diagnosis or recommendation for treatment of your particular medical situation. If you are unwell, concerned about your physical or mental state, or are experiencing symptoms you should speak with your doctor or primary health care provider. If you are in medical distress, please contact emergency services (such as 911).