Budesonide + formoterol fumarate dihydrate for the treatment of asthma

ABSTRACT

Introduction: One of the most widely used fixed combinations in asthma management is dry powder budesonide+formoterol fumarate dihydrate which is commercially available as Symbicort Turbuhaler® (and generic products), Easyhaler Bufomix® and DuoRespSpiromax® inhaler. The aim of this paper was to review the fixed dry powder combination of inhaled budesonide+formoterol fumarate dihydrate for asthma treatment in adolescents and adults.

Areas covered: A literature search using relevant search terms, reference lists for reviews and meta-analyses was performed.

Expert opinion: In symptomatic adolescent and adult patients with asthma maintenance and reliever therapy with a single-inhaler fixed combination of dry powder budesonide+formoterol fumarate dihydrate is an evidenced option. The combination treatment is convenient to patients. It reduces the number of exacerbations requiring treatment with oral corticosteroids. In some patients the strategy may also reduce the total intake of inhaled corticosteroids over time. Whether important outcome measures of asthma treatment, such as hospital admission and emergency room visit rates, may be reduced is less well documented since the published studies may have been influenced by publication bias. Non-pharmaceutical company-sponsored research evaluating such measures is needed. There is no evidence for the use of single inhaler fixed combinations of inhaled corticosteroids+long-acting β₂-agonists in children (<12 years of age), and budesonide+formoterol fumarate dihydrate should not be prescribed to the age group.

KEYWORDS:

• Asthma
• bioavailability
• budesonide
• formoterol
• formoterol fumarate dihydrate
• inhaled corticosteroids
• inhaled steroids
• long-acting β2-agonists
• short-acting β2-agonists
• pharmacokinetics
• systemic activity
• hypothalamic-pituitary-adrenal function

Declaration of interest

In the past 5 years O D Wolthers has received research funds, advisory board salaries, lecturing salaries, meeting sponsorships from and/or he has been an investigator on clinical trials for Alk-Abello, GlaxoSmithKline, Berlin-Chemie Menarini, Teva UK Ltd and Mundipharma Research Ltd. He has not been and is not employed by any of the companies, and he has no stock ownership or any compensation tied directly to the success of any of the companies. The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.