Symbicort confusion

[Birthday60]

Have had asthma since I was a few months old and in the early years there were no inhalers at all. Have recrntl6 been put on Symbicort (Smart) after I was told Seritide was being discontinued and that it would replace my ventolin reliever. As I have exercise induced asthma as well as allergy asthma I usually take a ventolin before excessive - i XC ski in the winter and Nordic walk in the summer so am no couch potato. Am a bit worried as when I used the Symbicort as a reliever I got absolutely no relief. Anyone else have the same concerns?

[PMRPete]

You don't say which Symbicort you are taking. You might like to add a puff or two of Oxis which is a sister product of Symbicort.

[Birthday60 in reply to PMRPete]

It’s the 200/6 which is used in SMART

[PMRPete in reply to Birthday60]

"The SMART dosing regimen applies to both the Symbicort 100/6 and 200/6 inhalers. Symbicort 400/12 is not licensed for use in this way."

mims.co.uk/symbicort-smart-...

[Lynneypin]

I have a back up ventolin which I’m prescribed just in case. I do use it occasionally.

[Griffon]

I understood Symbicort was a preventer , not a reliever - in which case you are using it incorrectly .

[Bobcat_44 in reply to Griffon]

Symbicort is a combination of Budesonide (preventer) and Formoterol (reliever).

asthma.org.uk/advice/inhale...

"The use of a combination inhaler containing budesonide and formoterol as both maintenance and quick relief therapy (SMART) has been recommended as an improved method of using inhaled corticosteroid/long-acting β agonist (ICS/LABA) therapy. Published double-blind trials show that budesonide/formoterol therapy delivered in SMART fashion achieves better asthma outcomes than budesonide monotherapy or lower doses of budesonide/formoterol therapy delivered in constant dosage."

[Superzob in reply to Bobcat_44]

It may be worthwhile writing to Asthma UK about this. The website simply explains the (S)MART regime, but doesn't say why this would work better than using salbutamol as a reliever. Both budesonide and Formoterol are long-acting so, whilst SMART might "achieve better outcomes than... monotherapy or lower doses of [Symbicort]", the trials don't seem to consider the situation where this fails to achieve the objective of calming an asthma attack; a short-acting medication like salbutamol would seem to be the appropriate response. As a risk-averse individual, I always recommend having a Plan B; I use Symbicort (but not under a SMART regime), but I have salbutamol as a standby.

[Bobcat_44 in reply to Superzob]

" Symbicort SMART enables patients to use only one inhaler, the budesonide-formoterol combination inhaler, for both maintenance and reliever therapy.

It is important that the temporary reliever medication includes not only a bronchodilator but also an antiinflammatory drug because worsening of asthma includes not only more airway narrowing, but also an increase in airway inflammation. The Symbicort SMART concept therefore ensures that the patient gets an antiinflammatory drug at the time of the first signs of asthma worsening. Clinical results show that Symbicort SMART prolongs the time to the first severe asthma exacerbation, reduces the rate of exacerbations, and maintains day-to-day asthma control at a reduced load of corticosteroids (inhaled plus systemic) when compared with higher fixed maintenance doses of combination inhalers."

And formoterol works as quickly as salbutamol.

[Superzob in reply to Bobcat_44]

i stand corrected! The research is at ncbi.nlm.nih.gov/pubmed/178....

However, if Birthday60 is not getting relief from the SMART regime, then the use of Ventolin in addition to Symbicort should be OK, since this is the advice I've been given.

[Birthday60 in reply to Griffon]

the consultant has recommended the SMART method which is 2 puffs twice daily plus ups to 8 more puffs if I am breathless but I read that if you have excessive induced asthma you should still take a ventolin before you start rigorous excessive - the problem is that most asthma nurses and many consultants are not used to meeting active sportspeople but mainly people are sedantary or poor excercise