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Respiratory Diseases
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Aref T. Senno, Ryan K. Brannon
Long-acting β-agonists: Produce bronchodilation for at least 12 hours after a single dose. They are not to be used as monotherapy for long-term control of asthma. Instead, they are used in combination with inhaled corticosteroids for both immediate treatment of exacerbations and long-term control/prevention of symptoms in moderate or severe persistent asthma. Only formoterol-budesonide (Symbicort) has been evaluated as a rescue inhaler. LABAs have been shown to be more effective than leukotriene receptor antagonists (LTRAs) or theophylline as add-on therapy to inhaled corticosteroids [2].
Paper 3
Published in Aalia Khan, Ramsey Jabbour, Almas Rehman, nMRCGP Applied Knowledge Test Study Guide, 2021
Aalia Khan, Ramsey Jabbour, Almas Rehman
Symbicort® is a combination of which of the following asthma drugs? Budesonide and formoterolFluticasone and salmeterolBudesonide and sodium cromoglicateBeclomethasone and formoterolIpratroprium and salmeterol
Case studies
Published in Anita Sharma, David Pitchforth, Gail Richards, Joyce Barclay, COPD in Primary Care, 2018
Anita Sharma, David Pitchforth, Gail Richards, Joyce Barclay
This is ‘frequent exacerbation.’Add Seretide 250 Accuhaler (salmeterol 50 mcg plus fluticasone propionate 250 mcg) to be taken twice a day, or Symbicort Turbohaler 200/6 (budesonide 160 mcg plus formoterol 4.5 mcg per metered inhalation) to be taken twice a day.Increase the dose depending on symptom relief.A 70-year-old man with severe COPD has noticed that he has swollen ankles.
Comparing a fixed combination of budesonide/formoterol with other inhaled corticosteroid plus long-acting beta-agonist combinations in patients with chronic obstructive pulmonary disease: a review
Published in Expert Review of Respiratory Medicine, 2019
Paolo Solidoro, Filippo Patrucco, Diego Bagnasco
Treatment escalation is almost inevitable in COPD, which is a progressive condition that cannot be cured [1], and most patients take a combination of inhaled therapies [9]. Therefore, fixed combinations of inhaled agents have been developed to facilitate patient adherence and regular use. At least four fixed-dose combinations of ICS/LABA are available for use in COPD, including budesonide/formoterol (Symbicort®, Astra Zeneca), beclomethasone/formoterol (Fostair®, Chiesi Limited), fluticasone/vilanterol (Relvar®, GlaxoSmithKline), and fluticasone/salmeterol (Seretide®, GlaxoSmithKline), which are available in a number of different inhalers. However, there are very few comparative studies of these combinations to help guide clinicians in their decision-making about which of these combinations to prescribe.
Prescribing trends of inhaler treatments for asthma and chronic obstructive pulmonary disease within a resource-constrained environment in the Scottish national health service: findings and implications
Published in Expert Review of Respiratory Medicine, 2019
Holly McCabe, Brian Godman, Amanj Kurdi, Katie Johnston, Sean MacBride-Stewart, Janey Lennon, Simon Hurding, Marion Bennie, Alec Morton
We are also aware that alternatives to Seretide® and Symbicort® are typically priced at a discount of only 20% to 30% below originator prices rather than the 85% to 95% reductions seen for generic PPIs, statins and selective serotonin re-uptake inhibitors (SSRIs) versus pre-patent loss prices [42,53,54]. As a result, expenditure on LABA/ICS and LAMA inhalers has grown in recent years to become the highest of any medicine type in Scotland. To help address this, new lower cost LABA/ICS inhalers, e.g. Fostair® (beclomethasone/formoterol) and Revlar® (fluticasone furoate/vilanterol) have recently been promoted by the Health Boards in Scotland as the preferred first and second line choices [39–41]. There were concerns initially that these new inhalers did not have the same dose range as Seretide® and Symbicort®, which made it difficult to titrate care. In addition at the time of their launch, there were ongoing initiatives with Health Boards to encourage physicians to step down inhaler doses particularly the steroid burden in line with current guidance (BTS/SIGN). Consequently, it was perceived as challenging to initiate this steroid dose change as well as switch patients between different inhaler types. There was also a need for all key stakeholders to become comfortable with Fostair® or Revlar®, which resulted in a gradual uptake initially as well as acknowledging the resource implications with patient training [50]. There have also been concerns with the licensed indications of these alternatives versus Seretide® and Symbicort® when initially available.
Breathing pattern recordings using respiratory inductive plethysmography, before and after a physiotherapy breathing retraining program for asthma: A case report
Published in Physiotherapy Theory and Practice, 2018
Rokhsaneh Tehrany, Ruth DeVos, Anne Bruton
After the BR, the patient reported reducing the number of puffs of Salbutamol that she took from between 9 and 12 a day, to around 6 a day (Table 3). The average minimal patient perceivable improvement for inhaled beta-agonist use is said to be −0.81 puffs a day (Santanello et al., 1999). However, the patient’s GP changed her medication from Symbicort to Fostair 6 weeks after starting her BR. Symbicort and Fostair are both combination inhalers. They contain a long-acting beta-agonist to relieve ongoing symptoms, such as breathlessness and a tight chest, plus a corticosteroid to prevent inflammation in the airways over the long term. Symbicort is combined budenoside and formoterol, while Fostair is combined beclomethasone and formoterol. These inhalers are said to be similar in efficacy, but no trials have made direct comparisons between them. A reliever inhaler (such as Salbutamol) is usually prescribed as well, as in the patient’s case, to give immediate on-the-spot relief from asthma symptoms (Asthma UK, 2016)