Symbicort strategy approved for use in UK
Symbicort users may need support from their pharmacist |
A new asthma management strategy for adults, which does not incorporate the use of a short-acting beta2 agonist, has been granted approval in the UK.
The strategy involves a combination of budesonide and formoterol (Symbicort;
AstraZeneca) used twice a day as regular asthma prevention, but also
used as needed in response to symptoms. Patients therefore only need
to use one type of inhaler.
A study published last month in the International Journal of Clinical
Practice showed that “Symbicort maintenance and reliever therapy” (SMART)
reduces the risk of severe asthma exacerbations when compared with budesonide/formoterol
and fluticasone/salmeterol maintenance therapies, both with terbutaline
as reliever (2007;61:725). The study, funded by AstraZeneca, involved
3,335 asthma patients.
Anna Murphy, consultant respiratory pharmacist, University Hospitals
of Leicester NHS Trust, commented: “The SMART approach is only
possible because of the unique profile of the formoterol component; formoterol
is the only long-acting beta2 agonist available that has a fast onset
of action (similar to salbutamol or terbutaline) and a wide dose-response
relationship.”
Accordingly, the new approach is not achievable with any other combination
product currently on the market, she pointed out. “Although SMART
is not included in the current British Thoracic Society and Scottish
Intercollegiate Guidelines Network asthma guidelines, it does fit with
the principles of those guidelines — achieving and maintaining
asthma control with the lowest effective dose of inhaled steroid,” Ms
Murphy said.
She also pointed out the need for pharmacists to be aware of the new
approach: “Patients may need support in understanding the principles
of their new inhaler and reassurance that they do not need a separate ‘blue’ inhaler.
Communication is key to successful management — everyone involved
in the patient pathway must be aware that the patient is prescribed SMART.”
Early data on the strategy were previously reported in The Journal (22
January 2005, p75, and 26
August 2006, p242).
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