symbicort smart

can someone explain this treatment. I always thought it best to take steroid regularly and yet this one says to use it when got symptoms so not sure I fully understand the logic although have heard good reports.

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Hello Sam1,

Symbicort SMART has been discussed extensively on here in the past, so if you use the search facility then you should find some useful information.

To explain it briefly, the Symbicort SMART programme uses an ordinary Symbicort inhaler, which is a combination of budesonide (a steroid) and formoterol (a long acting, but quick onset, reliever - a beta-2 agonist). The difference is that users do take a maintenance dose of the inhaler morning and night, but can use extra puffs during the day if needed for symptoms - up to 8 - 12 puffs per day.

This means that the user is getting the reliever they need to deal with their acute symptoms, but is also getting an increase in the amount of steroid they are taking, to better control the underlying asthma - because they can't help but take steroid with their reliever, the increase in steroid generally happens a day or so sooner than it would if one were required to first realise that one were using more reliever, and then decide to step up the preventor. Preliminary results do suggest that in some people this results in better asthma control.

So you can see that on this regimen people are still having steroid regularly as a maintenance dose, they are just having an extra dose on top when their control is less good.

Hope this helps

Em H

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Hi Sam1 /EmH

I too am a bit confused/worried about the SMART Symbicort idea. I have recently (Sept) been changed onto this regime from Seretide 250. It sounded like a really good move for me as i am a bit scatty with my meds sometimes (not deliberately)and it seemed a bit easier. However upon reading some of the recent posts i am a bit worried about the dose i have been prescribed.

I have the 400/12 inhaler which i can take up to 12 times a day plus ventolin if needed. My maintenance dose is 2xpuffs morning and evening. The thing that bothers me is that i understand (with my limited knowledge!) that the 400/12 inhaler is not licensed to be used in this way and it seems like quite a big dose to me if you take 12 puffs a day??

When i mentioned it to my GP she didnt seem to make anything of it and in fact didnt really seem to know herself. In fact the only person that has commented on the dose was my pharmacist, who just advised me not to take 12 doses a day unless really necessary. Even the patient notes with the inhaler say that the 400/12 dose should not be used with the SMART protocol.

I am sorry to 'go on' a bit, but i would also value anyone elses views/ideas and also to see if anyone else is on the same regime as me.

Sam1 have you found it any better? and what dose/inhaler are you on??

Many thanks

Flip

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Hi Flipper,

You are right, that does seem like a high dose. The Symbicort SMART regimen is licensed for use with Symbicort 200/6 and Symbicort 100/6. The patient and healthcare professionals websites both state that Symbicort 400/12 is not appropriate to use with the SMART dosing regimen. You can see the websites at symbicort.com

If you were to take 12 puffs a day of Symbicort 400/12, this would give you 4800mcg of budesonide and 144mcg of formoterol - the BNF limits are 1600mcg of budesonide and 54mcg of formoterol. Whilst doses higher than BNF limits are occasionally used, this is usually in people who have severe asthma, are on maximum treatment of all the alternative agents, and are under the regular and close supervision of a respiratory consultant. Even in such people, doses like this would be considered to be very high.

Taking such high doses puts you at increased risk of side effects; it is also worrying in terms of your asthma control. If your asthma is poorly controlled enough to require 12 puffs a day of the high dose formulation, you should really be seeing your doctor for a full assessment and consideration of referral if you are not already under a consultant. There are other add-on medications that should be considered before going up to these extreme doses.

I would go back and discuss this with your doctor, making it clear that you are aware of what the correct regimen should be. It may be that this is an oversight and that you would be well controlled on the lower dose inhaler.

Hope this helps

Em H

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Hi EmH

Many thanks for your advice. I am glad that someone sees my point of view - i was beginning to think that i had the wrong end of the stick! I looked at the websites you recommended and they seemed to reiterate what i had thought/seen elsewhere - thanks.

You are right - the symbicort was prescribed by my cons ( or at least his registrar or something) the last time i went to see him. I have to go again in about 4 weeks time. I have taken a variety of things that havent really worked - singulair/seretide - but like you i dont think that the list of possible treatments has been exhausted enough to put me on this dose of symbicort - but i feel a bit awkward if i question these guys too much - i feel out of my depth really as i am grateful that i am getting some help.

I am also a little bit reluctant to hassle my GP about my meds - because she has been really good to me and i feel that all i do is complain at her all the time. I dont want her to think that i am a 'know all' who wont take advice. However, do you think i should just mention this at my next clinic visit ?

Sorry what a whinging post! Here i go again......

Well i am still really interested to hear from other people on their thoughts/ideas about Symbicort SMARTand the regimes they use.

Thanks again!

Flip

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Hi Flipper,

I think it's important that you feel able to question and clarify treatment decisions with your consultant and GP - you are entitled to have an understanding of why you have been put on certain treatments and what the risks and benefits are. You are also entitled to make an informed decision about whether you wish to consent to a particular treatment that your doctors have suggested. Provided you address the issue calmly and in a spirit of enquiry about your own condition, rather than in a confrontational or hostile fashion, I can't see why any doctor would have a problem with you asking these sorts of questions.

It may be that your respiratory consultant feels that your asthma is severe enough to merit giving these high doses and using the Symbicort 400/12 inhaler in an unlicensed way - but if this is the case, this is certainly something that your consultant should discuss with you. Getting informed consent from a patient (which includes discussing the risks and benefits of a drug) should be standard procedure for any medication, but this is even more the case when a drug is being used off-license.

Personally, I would be very surprised if my consultant suggested that I take these sorts of doses of Symbicort - and I have brittle asthma with multiple hospital admissions and have tried pretty much every class of asthma medication available.

Hope this helps - please do raise this with your consultant!

Take care

Em H

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Flipper,

I had a similar thing happen to me, I went to clinic a month before Symbicort Smart was due to come out and they said I could start taking it as and when as well as stepping up to 3 puffs bd when needed. So I did and at one point must have taken 2 3 puff doses and about 6 or 7 one puff doses (trying to keep myself out of A and E) after reading the stuff on here and speaking to my boyfriend's mum who is a pharmacist I realised that I shouldn't have taken that much. When I went back to clinic last week the registrar told me that I could only go up to 3 puffs bd and take no more than that. Unless they changed my inhaler to the 200/6 so my usual dose would be 4 puffs morning and evening! So we decided to stick with the original plan.

Do you have a number you can ring if you have questions? I have the number of my respiritory nurse who I can call to ask questions if needs be.

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Hi Everyone

Many thanks for your replies. The advice is gratefully received.

EmH you are right - my asthma is annoying and frustrating at times but it is not as bad as a lot of the people who post on this site, including yourself. I think this is even more reason why i find this all so confusing.

I will however try to discuss this with my cons when i next see him - as you advised. In the meantime i will try to keep my use of Symbicort to a minimum. Do you think that it could be a prescribing/comunication error? or is that not possible? Do you also think that i should speak to my GP before my cons? I am sorry for all the questions - but i dont really have anyone else who is familiar with asthma to run them by.

Beth - i dont have any contact with an asthma nurse either at my surgery or at the hospital. I have asked at the surgery to speak to a nurse when i have had probs, as i do not like to hassle the doctors but they do not appear to have a dedicated nurse or are reluctant to put me through - i just get put onto a doctor. Im not sure whether they have one or not - i cant get to the bottom of it. Any reviews i have are with a doctor.

Well thanks again everyone for the advice.

Flip

ps. I am sorry Sam1 for hijacking your thread.

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Bumping up this thread in response to a request by PM.

Em