Respiratory - Compound (β2-agonist–corticosteroid) inhalers: Seretide®, Symbicort®

Question 1

Compound (β2-agonist–corticosteroid) inhalers: Seretide®, Symbicort®

Common Indications

Answer 1

Asthma: ​

• control of symptoms and prevention of exacerbations, used at ‘steps 3–4’ in the management of chronic asthma.

Chronic obstructive pulmonary disease (COPD):

• to control symptoms and prevent exacerbations in patients who have severe airflow obstruction on spirometry and/or recurrent exacerbations.

Question 2

Compound (β2-agonist–corticosteroid) inhalers: Seretide®, Symbicort®

Mechanisms of Action

Answer 2

• Compound inhalers contain an inhaled corticosteroid to suppress airway inflammation, and a long-acting β2-agonist (LABA) to stimulate bronchodilation.
• The prescription of these drugs in combination reduces the number of different inhalers that need to be taken and increases adherence to treatment.
• In asthma, compound inhalers ensure that long-acting β2-agonists are not taken without an inhaled corticosteroid.
• This is important because, without a steroid, long-acting β2-agonists are associated with increased asthma deaths.
• In COPD, combined treatment is more effective in reducing exacerbations than either drug alone.

Seretide® contains fluticasone and salmeterol. Symbicort® contains budesonide and formoterol.

Question 3

Compound (β2-agonist–corticosteroid) inhalers: Seretide®, Symbicort®

Important adverse effects

Answer 3

• Inhaled corticosteroids most commonly cause local adverse effects, including oral thrush and a hoarse voice.
• There is some evidence that they increase the risk of pneumonia in people with COPD.
• Where used at very high doses for a long time, systemic adverse effects including adrenal suppression, growth retardation (children) and osteoporosis may occur.
• Long-acting β2-agonists can cause tremor, tachycardia, arrhythmias and muscle cramps.

Question 4

Compound (β2-agonist–corticosteroid) inhalers: Seretide®, Symbicort®

Practical Prescribing

Answer 4

• You should prescribe compound inhalers by proprietary (brand) name, inhaler type and strength.
• Strength describes the amount of medicine per inhalation, e.g. Symbicort® Turbohaler 400/12 contains 400 micrograms of budesonide and 12 micrograms of formoterol per inhalation.
• Seretide® 500 Accuhaler contains fluticasone 500 micrograms and salmeterol 50 micrograms per inhalation.
• You should specify the number of inhalations and dosing frequency, e.g. Symbicort Turbohaler® 400/12 two puffs twice daily.