Budesonide with eformoterol (Symbicort Rapihaler) for asthma and COPD

The new listing is for three dose levels: budesonide with eformoterol fumarate dehydrate 50 micrograms/3 micrograms, 100 micrograms/3 micrograms and 200 micrograms/6 micrograms per dose.

These doses are half the respective doses available in the Turbuhaler DPI device (see Table 1) because dosing with the Rapihaler is designed to be given in multiples of two actuations to ensure adequate dose uniformity, while Turbuhaler can be given as single actuations.⁴ Ensure patients are made aware of the dosage differences between the two products.

Base a decision to use a pMDI or a DPI device on patient preference and their ability to use a device correctly.⁶ In general, patients with adequate inspiratory force and adequate hand–inhalation coordination can use either a DPI or a pMDI.

Use of a spacer is recommended for all patients using a corticosteroid-containing inhaler.⁷ Spacers improve dose delivery and also lower the amount of drug deposited in the mouth, reducing the incidence of adverse events such as oropharyngeal candidiasis (thrush).⁷

Guidelines recommend that patients use one type of device and avoid switching.⁶ If a patient is responding well to treatment with a Turbuhaler, it may not be appropriate to consider changing to the Rapihaler device.

The Rapihaler device may be a good alternative for those whose symptoms have not been successfully controlled using a Turbuhaler despite repeated instructions on its appropriate use.⁶

Both pMDI and DPIs such as Turbuhalers, have been associated with incorrect inhaler technique in patients with asthma or COPD resulting in suboptimal treatment.⁸ Guidelines recommend repeated demonstration and reassessment of device technique to optimise drug delivery.⁶