Date - 22 June 2005

Source- Drugs in Context 2005; 1(4): Symbicort® - Asthma p151

Author - Dr Eleanor Bull

Budesonide is an inhaled corticosteroid with high local anti-inflammatory activity. Compared with other reference corticosteroids (e.g. beclometasone dipropionate), budesonide demonstrates a high ratio of topical-to-systemic activity. Owing to a unique esterification process, budesonide is retained in airways tissue longer than any other inhaled corticosteroid, thus prolonging the duration of its anti-inflammatory effects. When administered via the Turbohaler^® dry powder inhaler, approximately 34% of a metered dose of budesonide is deposited in the lungs. Extensive clinical trials of budesonide have demonstrated that it effectively controls mild-to-severe persistent asthma in children and adults, eliciting significant improvements in lung function (forced expiratory volume in 1 second [FEV1] and peak expiratory flow [PEF]) and asthma symptoms, and also reduces the frequency of nocturnal awakenings and the use of ß2-adrenoceptor (ß2-agonist) rescue medication. These improvements are generally dose-dependent and budesonide is clinically effective at low doses (e.g. 200-400 µg). Budesonide reduces the need for oral corticosteroids in patients with more severe asthma. Moreover, budesonide is associated with a comparatively low incidence of clinically relevant systemic adverse events (e.g. adrenal suppression, growth retardation, metabolic disturbances). Instead, sore throat, hoarseness and an irritant cough are the most common side-effects associated with long-term treatment. As with all inhaled corticosteroids, the budesonide treatment regimen should be tailored to the individual patient, and the dose of budesonide should be maintained at the minimum effective dose necessary to maintain good asthma control.

Keywords: Asthma, budesonidem, formoterol, Symbicort^®, combination therapy