Comparing clinical efficacy of Symbicort versus Pulmicort in reducing asthma symptom and improving its control


1 Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

2 Department of Metabolic Syndrome, Isfahan Cardiovascular Research Centre, Isfahan University of Medical Sciences, Isfahan, Iran

3 Department of Surgery, Isfahan University of Medical Sciences, Isfahan, Iran


Background: Recently, higher efficacy of the combination of long-acting beta2-adrenoceptor agonist and inhaled corticosteroids on controlling asthma symptoms has been hypothesized. This study aimed to examine the clinical effects of the combination of Budesonide with formoterol (Symbicort) and Budesonide (Pulmicort) alone in persistent asthma.
Materials and Methods: In a randomized double-blinded clinical trial, 76 patients with definite diagnosis of moderate-to-severe asthma were randomized to receive Pulmicort 180 mcg/inhalation two puffs twice daily, or receive Symbicort 80/4.5 mg/inhalation two puffs twice daily, or receive Symbicort 160/4.5 mg/inhalation two puffs twice daily for 3 months. All participants were initially evaluated by spirometry for assessing respiratory parameters and also the level of asthma control was assessed by Asthma Control Test (ACT).
Results: More significant improvement in spirometry parameters, including forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), FEV1/FVC ratio, as well as in peak expiratory flow (PEF) in both groups of Symbicort with the regimens 80/4.5 mg/inhalation or 160/4.5 mg/inhalation 2 puffs twice daily compared with Pulmicort group, ACT score was significantly improved in Symbicort group with the regimens 160/4.5 mg/inhalation compared with both Symbicort groups with lower dosage and Pulmicort group . Response to treatment in PEF parameter and also in ACT level was significantly more in those who received Symbicort with the regimens 160/4.5 mg/inhalation compared with other two interventional groups adjusted for gender and age.
Conclusion: Symbicort with the regimens 160/4.5 mg/inhalation has higher efficacy in reducing asthma symptom and improving its control compared with low doses of this drug and with Pulmicort.


1. Chung KF, Caramori G, Adcock IM. Inhaled corticosteroids as combination therapy with beta-adrenergic agonists in airways disease: Present and future. Eur J Clin Pharmacol 2009;65:853-71.   Back to cited text no. 1
2. McCormack PL, Lyseng-Williamson KA. Budesonide/formoterol: A review of its use as maintenance and reliever inhalation therapy in asthma. Drugs 2007;67:2407-31.  Back to cited text no. 2
3. Essilfie-Quaye S, Ito K, Ito M, Kharitonov SA, Barnes PJ. Comparison of Symbicort® versus Pulmicort® on steroid pharmacodynamic markers in asthma patients. Respir Med 2011;105:1784-9.   Back to cited text no. 3
4. Korn S, Vogelmeier C, Buhl R. Budesonide/formoterol maintenance and reliever therapy. A new treatment approach for adult patients with asthma. Med Klin (Munich) 2008;103:299-310.   Back to cited text no. 4
5. Bousquet J, Boulet LP, Peters MJ, Magnussen H, Quiralte J, Martinez-Aguilar NE, et al. Budesonide/formoterol for maintenance and relief in uncontrolled asthma vs. high-dose salmeterol/fluticasone. Respir Med 2007;101:2437-46.   Back to cited text no. 5
6. McFadden ER Jr. Asthma. In: Braunwald E, Fauci AS, Kasper DL. Harrison's principle of internal Medicine. 15 th ed. New York: McGraw Hill; 2001. p. 1456-63.  Back to cited text no. 6
7. Edwards SJ, von Maltzahn R, Naya IP, Harrison T. Budesonide/formoterol for maintenance and reliever therapy of asthma: A meta analysis of randomised controlled trials. Int J Clin Pract 2010;64:619-27.   Back to cited text no. 7
8. Pauwels RA, Lofdahl CG, Postma DS, Tattersfield AE, O'Byrne P, Barnes PJ, et al. Effect of inhaled formoterol and budesonide on exacerbations of asthma. Formoterol and corticosteroids establishing therapy (FACET) International study group. N Engl J Med 1997;337:1405-11.  Back to cited text no. 8
9. Usmani OS, Ito K, Maneechotesuwan K, Ito M, Johnson M, Barnes PJ, et al. Glucocorticoid receptor nuclear translocation in airway cells after inhaled combination therapy. Am J Respir Crit Care Med 2005;172:704-12.  Back to cited text no. 9
10. Roth M, Johnson PR, Rudiger JJ, King GG, Ge Q, Burgess JK, et al. Interaction between glucocorticoids and beta2 agonists on bronchial airway smooth muscle cells through synchronized cellular signalling. Lancet 2002;360:1293-9.  Back to cited text no. 10
11. Chuchalin AG, Svensson K, Stahl E, Ovcharenko SI, Goriachkina LA, Sidorenko IV, et al. A health-related quality-of- life comparison of formoterol (Oxis) Turbuhaler plus budesonide (Pulmicort) Turbuhaler with budesonide Turbuhaler alone and noncorticosteroid treatment in asthma: A randomized clinical study in Russia. Respiration 2002;69:427-33.  Back to cited text no. 11
12. Strandberg K, Palmberg L, Larsson K. Effect of budesonide and formoterol on IL-6 and IL-8 release from primary bronchial epithelial cells. J Asthma 2008;45:201-3.  Back to cited text no. 12
13. Barnes PJ. Scientific rationale for using a single inhaler for asthma control. Eur Respir J 2007;29:587-95.  Back to cited text no. 13
14. Gibson PG, Saltos N, Fakes K. Acute anti-inflammatory effects of inhaled budesonide in asthma. A randomized controlled trial. Am J Respir Crit Care Med 2001;163:32-6.  Back to cited text no. 14
15. Mendes ES, Pereira A, Danta I, Duncan RC, Wanner A. Comparative bronchial vasoconstrictive efficacy of inhaled glucocorticosteroids. Eur Respir J 2003;21:989-93.  Back to cited text no. 15
16. Turner MO, Hussack P, Sears MR, Dolovich J, Hargreave FE. Exacerbations of asthma without sputum eosinophilia. Thorax 1995;50:1057-61.  Back to cited text no. 16
17. Fahy JV, Kim KW, Liu J, Boushey HA. Prominent neutrophilic inflammation in sputum from subjects with asthma exacerbation. J Allergy Clin Immunol 1995;95:843-52.  Back to cited text no. 17
18. Whelan CJ, Johnson M, Vardey CJ. Comparison of the anti-inflammatory properties of formoterol, salbutamol and salmeterol in guinea-pig skin and lung. Br J Pharmacol 1993;110:613-8.  Back to cited text no. 18
19. Erjefalt I, Persson CG. Long duration and high potency of antiexudative effects of formoterol in guinea-pig tracheobronchial airways. Am Rev Respir Dis 1991;144:788-91.  Back to cited text no. 19
20. Advenier C, Qian Y, Koune JD, Molimard M, Candenas ML, Naline E. Formoterol and salbutamol inhibit bradykinin- and histamine-induced airway microvascular leakage in guinea-pig. Br J Pharmacol 1992;105:792-8.  Back to cited text no. 20
21. Baluk P, McDonald DM. The beta 2-adrenergic receptor agonist formoterol reduces microvascular leakage by inhibiting endothelial gap formation. Am J Physiol 1994;266:L461-8.  Back to cited text no. 21
22. Kallstrom BL, Sjoberg J, Waldeck B. The interaction between salmeterol and beta 2-adrenoceptor agonists with higher efficacy on guinea-pig trachea and human bronchus in vitro. Br J Pharmacol 1994;113:687-92.  Back to cited text no. 22