TeacherOfMedicine: Compound (β2-agonist–corticosteroid) inhalers

Asthma: control of symptoms and prevention of exacerbations, used at ‘steps 3–4’ in the management of chronic asthma.
Chronic obstructive pulmonary disease (COPD): to control symptoms and prevent exacerbations in patients who have severe airflow obstruction on spirometry and/or recurrent exacerbations.

Compound inhalers contain an inhaled corticosteroid to suppress airway inflammation, and a long-acting β2-agonist (LABA) to stimulate bronchodilation.
The prescription of these drugs in combination reduces the number of different inhalers that need to be taken and increases adherence to treatment.
In asthma, compound inhalers ensure that long-acting β2-agonists are not taken without an inhaled corticosteroid. This is important because, without a steroid, long-acting β2-agonists are associated with increased asthma deaths.
In COPD, combined treatment is more effective in reducing exacerbations than either drug alone.
Seretide® contains fluticasone and salmeterol. Symbicort® contains budesonide and formoterol.

Inhaled corticosteroids most commonly cause local adverse effects, including oral thrush and a hoarse voice.
There is some evidence that they increase the risk of pneumonia in people with COPD.
Where used at very high doses for a long time, systemic adverse effects including adrenal suppression, growth retardation (children) and osteoporosis may occur.
Long-acting β2-agonists can cause tremor, tachycardia, arrhythmias and muscle cramps.

High-dose inhaled corticosteroids, particularly fluticasone, should be used with caution in COPD patients with a history of pneumonia and in children, where there is potential for growth suppression.
Care should be taken when prescribing long-acting β2-agonists for patients with cardiovascular disease, in whom tachycardia may provoke angina or arrhythmias.

TeacherOfMedicine