Sharp respiratory diseasesFlu often cause complications. They are expressed in the inflammatory process in bronchops and lungs. Bronchitis is manifested by the following symptoms:

• cough;
• temperature increase;
• weakness;
• difficult breathing.

Timely treatment will avoid the development of pneumonia. Summary with inflammation of the bronchi is considered to be "symbicant". Instructions for use, analogues - all information will be presented below. The described medicines have differences in the composition. In this case, the testimony and contraindications are almost the same.

Form release

The remedy has anti-inflammatory and bronchological effects. Available in the form of a white granulated powder for inhalations. The main component of the drug component is considered to be Budesonide micronized in a dose of 80, 160 and 320 μg, as well as formoterol of fumarate dihydrate at a dose of 4.5 and 9 μg. The auxiliary component is the lactose monohydrate. The medicine is packed in metal inhalers designed for 60 and 120 doses.

The preparation of combined action to eliminate the attack two main substances tools have various effects on bronchi, thereby reducing the frequency of the basic properties of the drug allow you to apply them together with other groups for relief bronchial asthma.

Budesonide after the first inhalation within a few hours reduces the inflammatory process in bronchi, reduces the frequency of attacks and exacerbations of bronchial asthma. The mucous membrane of the bronchi becomes less empty, and the development of secretion is reduced.

Formoterol is a selective adrenoreceptor antagonist. After inhalation, the smooth muscles of bronchi in patients with bronchial obstruction relaxes quickly and for a long time. respiratory tract. After 3 minutes, the bronchhalytic effect comes, and it continues about semi-sufficient. Tradename medical "Simbicort Turbukhaler." Instructions for use, analogues - all information should be studied before the start of therapy.

Indications and contraindications

The medication can be assigned to the following pathologies:

• bronchial asthma of various etiology;
• COPL.

Contraindications:

• age up to 6 years;
• age up to 12 years old, for dosage of medication in 320 μg;
• increased sensitivity to individual components of the drug;
• tuberculosis;
• infectious and bacteriological pathologies of the respiratory system;
• diabetes;
• severe form of hypertension;
• heart diseases.

Before starting treatment, it is necessary to thoroughly explore all the contraindications to the Simbicort preparation (160 / 4.5). Analogs should also be used after familiarizing with the instructions and advice with the doctor.

Dosage

The medicine is not intended for the treatment of initial signs of bronchial asthma. The selection and purpose of the dose depends on the severity of the disease and the individual characteristics of the body. This should be considered before the start of therapeutic process by combined means and when changing the dosage. The main task of the drug is to reduce the number of attacks and exacerbations of bronchial asthma.

Mostly prescribe inhalation twice a day at 80, 160 and 320 μg, depending on age and the occupying process. Analogs of "Simbicorta" will have similar recommendations. It is necessary to use the inhaler according to the instructions, and correctly inhale the drug to stop the attack.

Overdose will lead to the development of the following symptoms:

• tremor;
• tachycardia;
• headache;
• insomnia;
• reduced pressure.

In the event of an overdose, the patient is prescribed symptomatic treatment and spend the daily rate correction. The same recommendations will have existing analogues for the drug "Simbicort". The instruction describes the maximum permissible daily rate. But independently take the drug is not worth it. The tool can be assigned only a doctor.

Medicinal interaction

• "Ketoconazole";
• beta adrenoblocators;
• "County";
• "Dizeciramide";
• antihistamines;
• "Levodop";
• "Oxytocin";
• inhibitors of Mao.

Pregnancy and lactation

There are no reliable research on how the drug affects the fetus during pregnancy and feeding. The medicine is prescribed only when the benefit for the mother exceeds the risk to the fetus. Cheap analogues of "Simbikorta" are not recommended to be used in the first and third trimesters of pregnancy.

Side effects

Basically, the tool is moved well. Only in rare cases, the following adverse reactions may be observed:

• tachycardia;
• tremor;
• migraine;
• dizziness;
• nausea;
• vomiting;
• excitation;
• sleep disturbance;
• allergic reactions.

Simbicorta analogues can also lead to the development of the described symptoms.

The drug is stored at a temperature not higher than 30 degrees in an inaccessible place for children. The pharmacy is released on the recipe. It is recommended to gradually reduce the dosage of the means so as not to cause cancellation syndrome. The medicine is not intended for the severe forms of bronchial asthma in an individual purpose. Patients suffering from frequent attacks, the drug should always be with them.

With caution, it is necessary to use the means to patients with renal and liver failure. All these instructions need to be taken into account in the treatment of the Tourbuchaler symbiracort tool (160/4.5, 120 doses). Analogue may be similar in composition. Therefore, he will have the same recommendations.

Before using the drug, it is necessary to learn to use the inhaler so that the dose is evenly distributed in the larynx and the means in a short time removed the attack of the suffocation.

Analogue of "Simbikorta" in Russia - the drug "Benacourt"

The medicine refers to the GCS group for inhalations. Unlike the Tourbukhaler symbiracort tool, the medication is produced in the form of a fine-crystalline powder or a transparent solution. The main substance in the composition of the drug is considered to be Budesonide in a dose of 200, 250 and 500 μg. The auxiliary component serves sodium benzoate.

Designed for use inhalation method. It has anti-inflammatory, anti-allergic, immunosuppressive impact on bronet. It is well tolerated with long use. Does not have a mineralocorticoid action. Improvement in the work of the lungs is observed two hours after the use of the first dose. A positive therapeutic effect occurs after seven days of treatment. The drug does not stop the attack of suffocation, but is used to eliminate bronchial asthma. Identical impact is provided by the "Simbicort" agent. An analogue of Russian can be purchased at a pharmacy at an affordable price - about 400 rubles per pack. At the same time, the cost of the drug "Simbicort" is almost twice as high.

Professionals show that there is a significant difference, if we talk about the impact on the body, there is no two drugs. Therefore, it makes no sense to overpay for a more expensive drug.

Indications and contraindications

Medication is used for the following pathologies:

• bronchial asthma: as an anti-inflammatory agent in comprehensive application;
• chronic obstructive lung disease.

Contraindications:

• active form of tuberculosis;
• fungal and bacterial lesions of the lungs;
• acute bronchospasm;
• age up to 16 years;
• not an asthmatic form of bronchitis;
• glaucoma.

The same testimony and contraindications have other analogues for the preparation. The inhaler is also used in the co-treatment of bunches of bronchial asthma and contains a certain amount of doses.

Dosage "BenaCort" medication

Inhalation with medicine is carried out on a portable individual inhaler "Cyclohaler". The daily dose is established, depending on the severity of the flow of bronchial asthma and taking into account the characteristics of the patient's body. The initial dose may be a little more than when using the "Simbicort" tool and will be 400-1600 μg. The maximum dosage per day should not be higher than 2000 μg. It is distributed to 4 inhalations. The course of treatment is from 10 to 14 days.

Like other analogs ("Simbikorta", "Benakap"), the Benacurort means is compatible with all medicines. It is not recommended to carry out therapy with the following medicines:

• "Phenitoin".
• "Phenobarbital".
• "Rifampicin".
• "Ketonazole".
• estrogens.

Reviews of doctors show that with improper treatment of the drug, the following side effects may develop:

• redness of the mucosa;
• hoarseness;
• nausea;
• migraine;
• dizziness;
• sleep disturbance.

The drug "Benacourt" can be an excellent substitute for the "Simbicort" means. Analogs are cheaper, but often do not inferior in quality. Reviews of the Benacort Preparation for greater extent you can hear positive.

In rare cases, hypersensitivity to the current component can develop. It is manifested in the form of skin rashes and itching. Allergic reaction - a serious reason to consult a doctor. A specialist will be able to choose a qualitative substitute, and also prescribe an antihistamine agent.

"Benakap"

This medicine, in contrast to those described above, is produced in the form of droplets and belongs to the GCS group. Used for inhalation, local and intranasal applications. It has an anti-inflammatory, anti-allergic and anti-seventive impact, which, with the help of inhalation, reduces the development of secretion and obstruction in bronchi.

In the process of treatment, the function of the lungs is improved, the frequency of manifestations of shortness of breath is reduced, also passes the attack of suffocation and spasmodic cough. The maximum therapeutic effect is observed two weeks after applying. Similar effect Provides the drug "Simbicort Turbukhaler". Analogs are cheaper, but also perfectly reduce the number of asthma attacks.

Dosage "Benakap" medication

The dose depends on the age, the severity of the disease and the individual characteristics of the body. Sets the number of inhalations only the doctor. Analogs ("Simbikorta", "Benacourt" and other means) "Benakap" are mainly used for inhalation, in the form of a powder or solution.

• "Omeprazole".
• "Cimetidine".
• "Rifampicin".

There is no data on how droplets affect during pregnancy and lactation. Medication apply only when the benefit for the mother exceeds the risk to the fetus. The same recommendations will have other means of "symbicant" analogues. Professionals show that in practice it had to designate inhalers to pregnant women. Side phenomena No was detected. However, therapy is desirable to be carried out under observation.

"SERELET"

Preparation with bronchological and anti-inflammatory action. This medicine is produced in the form of an aerosol in the form of a white suspension. The main components of the drug are Salmeterol Xenofoat at a dose of 25 μg and fluticasone regime 50, 125 and 250 μg. The means of combined composition, which has a different impact. Medication "SERELET" is different in the composition of the drug "Simbicort Turbukhaler". Analogs, despite the difference in the existing components, have similar impact on the body.

Indications and contraindications

The "SERETS" means is prescribed under the following diseases:

• treatment of bronchial asthma in comprehensive use with other groups of funds;
• obstructive pulmonary disease.

Contraindications:

• increased sensitivity to components;
• age up to 4 years;
• tuberculosis in acute form;
• renal and liver failure;
• pregnancy;
• lactation;
• glaucoma.

Identical contraindications to treatment has a simbitistic preparation. Analogs are cheaper in most cases, but do not differ in the effectiveness of therapy. However, at the pharmacy, the substitute without recommendation is not worth the specialist. In rare cases, hypersensitivity can develop to a valid component, which manifests itself in the form of allergic reaction. If any unpleasant symptom appears, it is necessary to stop using the inhaler and consult a doctor.

Dosage

Drug "SERPEY" is used only for inhalations. The number of procedures per day establishes a doctor, depending on the severity of the disease and individual characteristics of the patient. Only regular use will help reduce the number of bunches of bronchial asthma. Cheap analogues of "Simbicorta" are used in the complex daily rate of the drug for a particular patient can only determine the doctor. Self-treatment is not desirable.

Comparison and reviews

Preparations "Simbikorta", "Seretide", "Benakap", "Benacourt" have various main substances, but identical testimony for use and a number of contraindications. All of them belong to the GCS group, which is used in the form of inhalations and aerosols. Many patients after treatment with these funds were able to reduce the number of attacks, remove the inflammatory process in bronchi, remove the symptoms of allergy and swelling of the mucous membrane. Most therapists prescribe these medicines for the treatment of bronchial asthma with long-term use.

A lot of good reviews You can hear about the simbitistic drug. Vectors are also widely used. Care prescribe treatment with renal and only minus - price. The Simbicort preparation is the most expensive of the above described (about 900 rubles per pack).

If you have failed to find a drug "Simbicort", analogs can not be cheaper, analogue can be used after consulting with a specialist. Cheap - does not mean poor quality. The preparations described perfectly remove the symptoms of bronchial asthma, despite the differences in the composition.

Pulmikort Turbukhaler is a hormonal therapeutic agent produced in the form of an instrument for individual use. The contents are powder and is used for inhalation multipoint. The remedy is located in a plastic bottle equipped with a special nozzle that ensures the dosage of the medication. In pharmacy chains, the drug is sold only by prescription.

In contact with

Odnoklassniki.

Instructions for the use of inhaler with a dose of budesonide 100mkg, 200mkgg

Pharmacological therapy should be approached with full responsibility. Nuances of use of the means of bulvikort Turbukhaler are described in detail in the instructions for use. Deviation from the rules is permissible only on the recommendation of the therapist or pulmonologist.

In which cases is assigned?

Reusable powder inhaler bulvikort Turbukhaler is effective in serious respiratory pathologies. It is recommended when detecting diseases caused by a protracted inflammatory process.

Table 1. In what cases is the powder inhaler

Active substance

According to the instructions for applying the active component in a multi-modular inhaler, Budesonide is served. This is a glucocorticoid hormone intended for local use. It is he who determines the actions of the bulvikort Turbukhaler as:

• anti-inflammatory;
• antihistamine;
• immunosuppressive;
• anti-shock;
• antitoxic.

The mechanism of action of glucocorticoid hormone is not given for estimates, but the pronounced local anti-inflammatory effect active component - proven fact. The rate of structural changes that affect pulmonary tissue and vessels is significantly reduced by reducing the response to the ejection of histamine.

Timely appointment of bulvikort Turbukhaler with and on early stages leads to a pronounced improvement in pulmonary activity.

Bronchial asthma

Contraindications

There are some restriction on the treatment of an individual inhaler bulvikort Turbukhaler. He is contraindicated for children under 6 years old. This is due to the fact that the use of budesonide can prevent the normal growth and development of the children's body. In addition, the tool is forbidden to apply under the individual intolerance to the components in the composition. Care should be taken to use the inhaler bulvikort Turbukhaler with:

• parallel purpose of inhalation with glucocorticoids;
• with different etiology;
• diseases of respiratory tract caused by the penetration of biological agents (fungi, bacteria, viruses).

Dose

The amount of drug is regulated for each patient individually depending on the diagnosis, age and distinctive features.

Important when selecting the amount of the drug is the appointment of the minimum active dose.

How to use?

The success of the therapy conducted by a reusable inhaler depends not only on the dosage, but also from the proper use of the device itself. It is very important to deeply inhale the pairs of means, as well as provide competent care for the inhaler itself.

Table 3. How to use inhaler bulvikort Turbukhaler

It should be remembered that exhaled through the mouthpiece is prohibited under any circumstances. The inhaler is recommended to clean with a tissue 1 time per week. Instructions for use notes that it is prohibited to use any liquids for its cleaning.

How to apply in the treatment of children?

The preparation under consideration refers to hormonal means. The use of a reusable inhaler in children and adolescence requires a clear compliance with the instructions and dosing regime.

The transition to the unite reception of the bulvikort Turbukhaler should occur only under the supervision of a pediatrician.

If necessary, long-term child's therapy or adolescent is extremely important to constantly track growth.

Special instructions for use

An impressive part of the instruction on the use of a reusable inhaler is described special instructions. No less important is the question of the compatibility of the bulvikort Turbukhaler with some drugs.

Table 4. Features of therapy with a reusable inhaler

Using a reusable inhaler does not entail a reaction rate reduction. That is why pharmacological therapy does not imply a refusal to driving a car and other activities requiring attention and concentration.

Review reviews

Mostly reviews about the pulmicort Turbukhaler are written in a positive vein, and the average patient assessment is 4.2-4.8 points out of 5 possible. The advantages of the drug include:

• high efficiency;
• action speed;
• the possibility of treatment during the period of tooling the child;
• comfortable bottle.

Positive experience describe and reviews telling about the treatment of children. However, there are negative aspects of the use of bulvikort Turbukhaler. The most obvious disadvantage is the high cost. In addition, many are afraid to use hormonal drugs To get rid of the pathologies of the respiratory tract.

Part of the patients notes that it is not always clear whether an aerosol is inhaled during the procedure due to the lack of any taste in the drug.

Analogs

In pharmacy chains, other funds based on budesonide are being implemented. There are the following analogues of the bulvikort Turbukhaler:

• Budenit Sherry Sky;
• Budesonide native and others.

Budenitis of stary-sky is a fine liquid intended for inhalation using a nebulizer. The active substance in the preparation begins to act about 60-120 minutes after the procedure. Sustainable condition improvement is marked after a couple of weeks of use. The remedy is recommended to prevent asthma seizures, but not effectively with acute bronchospasm. The drug is not available in the form of a reusable inhaler.

Budesonide-native has a pronounced bronchophycle and glucocorticosteroid effect. Is used for local application. It is injected inhalation with a nebulizer. Indication to the appointment, as in the case of the pulmist Turbukhaler, are bronchial asthma and COPD. The tool is not realized in the form of an aerosol, so it cannot be considered a full replacement.

The decision to appoint any drug takes a doctor

What is better bulvikort or symbistort?

Symbicort Turbukhaler is a combined drug, the key components of which are budesonide and formoterol. The latter is a broncholitic whose effectiveness is due to the electoral impact on beta receptors. Symbicort contributes:

• binding inflammation;
• removal of bronchospasm;
• getting rid of allergies.

In addition, the drug has a glucocorticosteroid effect. It is recommended to patients with a diagnosed bronchial asthma or chronic lung obstruction. The remedy is realized in the form of reusable powder inhalers. Indeed, the symbicort and bulvikort Turbukhaler are quite similar that it creates the question of what is better to choose for treatment.

The decision to appoint any of the funds can only be taken by a specialist. It is directly related to the diagnosis and individual characteristics of the patient.

Conclusion

1. Pulmikort Turbukhaler is an effective drug appointed under a number of respiratory pathologies.
2. His a distinctive feature is an high efficiency In the fight against the inflammatory process and a pronounced antiallergic effect.
3. The tool is made on the basis of a substance, competitively binding with glucocorticosteroid receptors, so requires a clear following instructions and recommendations of the specialist.
4. The drug is not used to treat children under 6 years.

In contact with

This article allows you to familiarize yourself with the instructions for use. medicinal preparation Simbicort. There are reviews of site visitors - consumers of this medicine, as well as the opinions of doctors of specialists in the use of symbicant in their practice. A big request to more actively add your reviews about the preparation: helped or did not help the medicine to get rid of the disease, which complications were observed and side effects, possibly not stated by the manufacturer in annotations. Analogs of symbicitant in the presence of available structural analogues. Use for the treatment of bronchial asthma and chronic obstructive pulmonary disease (COPD) in adults, children, as well as during pregnancy and breastfeeding. Composition of the drug.

Simbicort - Combined drug for the treatment of bronchial asthma. It contains formoterol and budesonides, which have different mechanisms of action and show an additive effect on reducing the frequency of the exacerbation of bronchial asthma. Special properties of budesonide and formoterol make it possible to use their combination simultaneously as supportive therapy and to relieve attacks, or as supporting therapy of bronchial asthma.

Budesonide - glucocorticosteroid (GKS), after inhalation has a fast (within a few hours) and dose-dependent anti-inflammatory effect on the respiratory tract, reducing the severity of symptoms and the frequency of the exacerbation of bronchial asthma. When appointing budesonide in the form of inhalation, there is a smaller frequency of serious undesirable effects than when using systemic GKS. Reduces the severity of edema of the mucous membrane of the bronchi, mucus products, the formation of sputum and the hyperreactivity of the respiratory tract. The exact mechanism of anti-inflammatory action GKS is unknown.

Formoterol is a selective beta2-adrenoreceptor agonist. After inhalation causes rapid and long-term relaxation of the smooth muscles of the bronchi in patients with reversible obstruction of the respiratory tract. The broncholy action is dose-dependent, occurs within 1-3 minutes after inhalation and is preserved for at least 12 hours after receiving a single dose.

Symbicant Turbukhaler: Budesonid + Formoterol

Bronchial asthma

Clinical effectiveness of symbicant as supporting therapy

With the combined use of formoterol and budesonide, the severity of the symptoms of bronchial asthma decreases, the lung function improves and the frequency of the exacerbation of the disease is reduced.

The action of the symbicant of the turbuchaler on the function of the lungs corresponds to the action of the combination of monopreparations of budesonide and formoterol and exceeds the effect of one budesonide. In all cases, beta2-adrenostimulator used to relieve attacks short action. There was no decrease in the anti-asthma effect over time. The drug is characterized by good tolerability.

Against the background of the reception of the symbicitort of the Turbukhaler as supportive therapy for 12 weeks in children aged 6 to 11 years (two inhalations of 80 / 4.5 μg / inhalation 2 times a day) improved the function of the lungs and was noted good tolerability of the drug compared to The corresponding dose of Budesonid Turbukhaler.

The clinical efficacy of symbicant as supportive therapy and to relieve attacks

In the course of observation of 4447 patients with a symbicant therapy as supportive therapy and to relieve attacks for from 6 to 12 months, a statistically and clinically significant decrease in the number of heavy exacerbations, an increase in the period before the first exacerbation in comparison with the combination of symbicant or budesonide As supporting therapy and beta2-adrenostimulator to relieve attacks. It was also noted effective control over the symptoms of the disease, a pulmonary function and a decrease in the frequency of the inhalation destination to relieve attacks. No development of tolerance for designated therapy was not revealed. In patients who applied for medical help In connection with the development of the acute attack of bronchial asthma, after the inhalation of the symbicorta, the relief of symptoms (removal of bronchospasm) has also occurred quickly and efficiently, as after the prescription of Salbutamola and Formoterol.

Cobl

In patients with severe COPD (OFV1 \u003d 36% before the treatment with symbicant) Against the background of the preparation of the drug Simbicort Turbukhaler, a significant reduction in the frequency of exacerbations of the disease was observed compared to patients received as therapy only formoterol or placebo (average frequency of 1.4 compared with 1.8- 1.9 in the placebo / formoterol group). There are no differences between the reception of the symbicort of turbuchaler and formoterol regarding the values \u200b\u200bof the FEV1.

Structure

Budesonide micronized + formoterol fumarate dihydrate + excipients.

Pharmacokinetics

SixbitoCort Turbukhaler bioequivalenten relevant monopreparatics (budesonide and formoterol) in relation to their systemic action. Despite this, a slight strengthening of cortisol suppression after taking the Tourbuchaler symbistort compared with monopreparatics was noted. This difference does not affect clinical safety. Evidence of pharmacokinetic interaction of budesonide and formoterol are absent. Pharmacokinetic indicators of budesonide and formoterol were comparable after their reception in the form of monopreparations and as part of the symbistort of Turbukhaler.

When applied combined drug The budesonide AUC was somewhat larger, the absorption of the drug was faster and the value of Cmax was higher; Cmax formoterol coincided with such for the monopreparation. Inhaled budesonide is quickly absorbed and reaches Cmax after 30 minutes. The average dose of budesonide that has fallen into the lungs after conducting inhalation through the turbochaler is 32-44% of the dose delivered. Systemic bioavailability is approximately 49% of the dose delivered. In children aged 6 to 16 years old, the average dose of budesonide, which has fallen into the lungs after conducting inhalation through the turbochaler, does not differ from the indicators in adult patients (the final concentration of the drug in the blood plasma was not determined).

Inhaled formoterol is quickly absorbed and reaches Cmax 10 minutes after the inhalation. The studies showed that the average dose of formyrene, which has fallen into the lungs after conducting inhalation through the turbochaler, is 28-49% of the dose delivered. Systemic bioavailability - about 61% of the dose delivered.

Binding of plasma proteins Budesonide is approximately 90%, formoterol - 50%.

Budoxonide is subjected to intensive biotransformation (about 90%) with the "first passage" through the liver to form metabolites with low glucocorticoid activity. The metabolism of budesonide is carried out mainly with the participation of the enzyme CYP3A4. The glucocorticoid activity of the main metabolites - 6-beta-hydroxybudesonide and 16-alpha hydroxyprednisolone - does not exceed 1% similar activity of budesonide.

Formoterol is metabolized mainly in the liver by conjugation with the formation of active O-demethylated metabolites, mainly in the form of inactivated conjugates.

There is no evidence of the interaction of metabolites or reaction of substitution between budesonide and formyrene.

Budesonide is excreted in the form of metabolites or in the form of conjugates and only in a small amount - unchanged. Budesonide has a high system clearance (approximately 1.2 l / min).

After inhalation, 8-13% of the delivered dose of formerol is removed unchanged with urine. Formoterol has a high system clearance (approximately 1.4 l / min); T1 / 2 is an average of 17 h.

Pharmacokinetics of formoterol in children and in patients with renal failure Not studied.

The concentration of budesonide and formoterol in the blood plasma can increase in patients with liver disease.

Indications

• bronchial asthma (insufficiently controlled by the use of inhaled glucocorticosteroids (GCS) and beta2-adrenomimetics of short-acting as therapy on demand, or adequately controlled inhalation GCS and beta2-adreminimetics long action). Symbicort Turbukhaler 80 / 4.5 μg / dose and 160 / 4.5 μg / dose can be used as supporting therapy and to relieve attacks;
• COPD (symptomatic therapy in patients with severe COPD (FEV less than 50% of the estimated estimated level) and with repeated exacerbations in history, if there are pronounced symptoms of the disease, despite the therapy by bronchodiators of long-term action).

Forms of release

Inhalation Powder Dosage Turbukhaler 80 μg + 4.5 μg (60 doses and 120 doses), 160 μg + 4.5 μg (60 doses and 120 doses), 320 μg + 9 μg (60 doses).

Other dosage forms, be something pills, drops or solution, does not exist.

Instructions for use and dosage

Symbicort Turbukhaler is not intended for the initial treatment of bronchial asthma intermittent and light persistent flow.

Selection of doses of drugs included in the symbicant of the turbuchaler is carried out individually and, depending on the severity of the disease. This must be taken into account not only at the beginning of the treatment with combined drugs, but also when the dose of the drug is changed.

In the event that individual patients require a different combination of doses of active substances than in the Simbicort Turbukhaler preparation, separately beta2-adrenomimetics and / or GCS in individual inhalers should be prescribed.

Bronchial asthma

SymbiCort Turbukhaler 80/45 μg / dose and 160 / 4.5 μg / dose

Patients should be under the constant control of the doctor for an adequate selection of the Tourbukhaler symbicant dose. The dose should be reduced to the smallest, against the background of which the optimal control of the symptoms of bronchial asthma remains. Upon reaching full control over the symptoms of bronchial asthma against the background of the minimum recommended dose of the drug, in the next step you can try the appointment of monotherapy inhalation GKS.

There are two approaches to the appointment of therapy Sixbitur Turbukhaler:

• as supporting therapy, the symbicort Turbukhaler is prescribed for constant supporting therapy in combination with a separate beta2-adrenostimulator short-acting to relieve attacks;
• as supporting therapy and to relocate attacks, the symbicant Turbukhaler is assigned both for constant supporting therapy and on demand when symptoms appear.

As supportive therapy

The patient needs to constantly have a separate inhaler with a beta2-adrenostimulator short action to relieve attacks.

Adults (18 years and older) are prescribed a symbicant Turbukhaler 80 / 4.5 μg / dose and 160 / 4.5 μg / dose of 1-2 inhalation 2 times a day. If necessary, an increase in dose of up to 4 inhalations is possible 2 times a day.

Teenagers (12-17 years old) are prescribed a symbicort Turbukhaler 80 / 4.5 μg / dose and 160 / 4.5 μg / dose of 1-2 inhalation 2 times a day.

Children over the age of 6 are prescribed a symbicant Turbukhaler 80 / 4.5 μg / dose of 1-2 inhalation 2 times a day.

After achieving the optimal control of the symptoms of bronchial asthma against the background of the drug 2 times a day, it is recommended to tite a dose to the smallest effective, up to reception 1 time per day, in cases where the patient's opinion requires supporting therapy in combination with a long-acting bronchodiators.

The increase in the frequency of the use of beta2-adrenostimulants of a short action is an indicator of the deterioration of overall control over the disease and requires revision of anti-asthma therapy.

As supportive therapy and to relieve attacks

The patient needs to constantly have a symbistort Turbukhaler to relieve attacks.

In this case, the drug is especially indicated by patients with insufficient control over bronchial asthma and the need for frequent use preparations for the relief of attacks; When indicating in the history of the exacerbations of bronchial asthma, demanding medical intervention.

Required to carefully control the appearance of dose-dependent side Effects In patients using a large number of inhalations to relieve attacks.

Adults (18 years and older) are prescribed a symbicort Turbukhaler 80 / 4.5 μg / dose and 160 / 4.5 μg / dose; Recommended dose - 2 inhalations per day: 1 inhalation in the morning and in the evening, or 2 inhalations 1 times a day only in the morning or only in the evening. Some patients can be appointed supporting the dose of the drug symbicort Turbukhaler 160 / 4.5 μg / dose 2 inhalation 2 times a day. If symptoms occur, it is necessary to assign 1 additional inhalation. With a further increase in symptoms, 1 additional inhalation is prescribed for several minutes, but not more than 6 inhalations to stop 1 attack.

It is usually no appointment of more than 8 inhalations per day, however, you can increase the number of inhalations to 12 per day for a short time. In patients who use more than 8 inhalations per day, revision of therapy is recommended.

SymbiCort Turbukhaler 80 / 4.5 μg / dose and 160 / 4.5 μg / dose as supportive therapy and to relieve attacks are not recommended for children and adolescents under the age of 18.

Symbicort Turbukhaler 320/9 μg / dose

Adults (18 years and older) The drug is prescribed 1 inhalation 2 times a day. If necessary, it is possible to increase the dose of up to 2 inhalations 2 times a day. After achieving the optimal control of the symptoms of bronchial asthma against the background of the drug 2 times a day, it is recommended to tite a dose to the smallest effective, up to reception 1 time per day.

Teenagers aged 12-17 are prescribed 1 inhalation 2 times a day.

Patients should be regularly visited by a doctor to control the optimal dose of the drug. The dose should be reduced to the smallest, against the background of which the optimal control of the symptoms of bronchial asthma remains. After achieving the optimal control of the symptoms of bronchial asthma against the background of the drug 2 times a day, it is recommended to tite a dose to the smallest effective, up to reception 1 time per day, in cases where the patient's opinion requires supporting therapy in combination with a long-acting bronchodiators.

Cobl

Adults are prescribed a symbiracort Turbukhaler 160 / 4.5 μg / dose of 2 inhalation 2 times a day or symbicant Turbukhaler 320/9 μg / dose of 1 inhalation 2 times a day.

There is no need for a special selection of the dose of the drug for elderly patients.

There is no data on the use of the symbicant of the turbuchaler in patients with renal or liver failure. Because Budesonide and formoterol are proposed mainly with the participation of hepatic metabolism, then in patients with severe liver cirrhosis, you can expect slowdown in the rate of removal of the drug.

Terms of use of Turbukhaler

The mechanism of action of the Turbukhaller is such that when the patient is inhaling through the mouthpiece, air flows are fond of medicinal substance in the respiratory tract.

It is necessary to instruct patient:

• carefully examine the "instructions for use" of the Turbukhaler;
• inhale strongly and deep through the mouthpiece to ensure the optimal dose of the drug into the lungs;
• never exhale through the mouthpiece;
• in order to minimize the possibility of the development of fungal damage to the rotogling, rinse the mouth with water after each inhalation. It is also necessary to rinse the mouth with water after conducting inhalations to relieve the symptoms and in the case of the development of the candidiasis of the mucous membrane of the oral cavity and pharynx.

The patient may not feel the taste or not to feel the drug after using Turbukhaler, which is due to a small amount of substance delivered.

Instructions for the use of Turbukhaler

Turbuchaler is a multi-cycle inhaler, allowing me to dose and inhale the drug in very small doses. When inhaling, the powder from the turbochaler is delivered to the lungs, so it is important that the patient is strongly and deeply inhaled through the mouthpiece.

Before first use, the turbukhaler must be prepared for work:

1. Unscrew and remove the cap.
2. Keep the inhaler vertically red dispenser down. Do not keep the inhaler for the mouthpiece while turning the dispenser. Rotate the dispenser to the stop in one direction, and then before the stop - in the opposite direction. Perform the described procedure twice.

Now the inhaler is ready to use, repeat this procedure Preparation of the Turbukhaler to work before each use is not required.

To receive one dose, the patient must execute the following procedure:

1. Unscrew and remove the cap.
2. Keep the inhaler vertically red dispenser down. Do not keep the inhaler for the mouthpiece while turning the dispenser. In order to measure the dose, turn the dispenser until it stops in one direction, and then before the stop - in the opposite direction. During this procedure, a click will be heard.
3. Exhale. Do not exhale through the mouthpiece.
4. Carefully place the mouthpiece between the teeth, squeeze your lips and breathe hard and deep through the mouth. The mouthpiece does not chew and do not compress her teeth.
5. Before breathing, remove the inhaler from the mouth.
6. If there is no inhalation of more than one dose, paragraphs 2-5 should be repeated.
7. Close the hat inhaler, check that the cap of the inhaler be carefully screwed.
8. Rinse your mouth with water, not swallowing.

It is impossible to remove the mouthpiece, because It is fixed on the inhaler and is not removed. Turbukhteller's mouthpiece rotates, but should not turn it without necessity.

Since the amount of inhaled powder is very small, you can not feel the taste of powder after inhalation.

However, absolutely accurate compliance with the instructions ensures inhalation (inhalation) of the required dose of the drug.

If the procedure for loading the inhaler has been repeated before taking the drug for an error, then when patients inhalation still receive one dose of the drug. At the same time, the dose indicator will show the total number of measured doses.

The sound that is heard when shook in the inhaler is produced by a drying agent, and not a medicinal substance.

The need to replace the inhaler

The dose indicator shows an approximate number of doses remaining in the inhaler, the dose of the turbuchaler doses begins with the 60th or 120th dose (depending on the total number of doses of the acquired Turbukhaler). The indicator shows the interval of 10 doses, so it does not show each died (loaded) dose.

Turbukhaler delivers the necessary dose of the drug, even if the change in the dose indicator window is not noticeable.

The appearance of a red background in the dose indicator window means 10 doses of the drug remained in the turbochalera. When the figures appear 0 on a red background in the middle of the window doses, the inhaler should be thrown out.

It should be paid to the fact that even when the indicator window shows the number 0, the dispenser continues to rotate. However, the dose indicator stops fixing the number of doses (moves to move) and digit 0 remains in the dose window of the inhaler.

Cleaning

Regularly (1 time per week) should clean the mouthpiece outside with a dry cloth. Do not use water or other liquids for cleaning the mouthpiece.

Disposal

Care should be taken when handling the used inhaler and remember that there can be some drug inside the inhaler.

Side effect

• headache;
• psychomotor excitation;
• anxiety;
• nausea;
• dizziness;
• sleep disorders;
• depression;
• behavior violations (mainly in children);
• violations of taste;
• feeling of heartbeat;
• tachycardia;
• atrial fibrillation;
• supported tachycardia;
• extrasystole;
• angina;
• hesitation hell;
• tremor;
• candidiasis of the oral mucosa and pharynx;
• easy irritation in the throat;
• cough;
• hoarseness;
• bronchospasm
• bruises;
• dermatitis;
• hives;
• angioedema edema;
• anaphylactic reactions;
• hypokalemia;
• symptoms of system action GCS (including hypofunction of adrenal glands).

The system effect of inhalation GCS may be observed when taking the drug in high doses for a long time.

Contraindications

• children's age up to 6 years (for all dosage forms);
• children's age up to 12 years (for dosage formcontaining budesonide 320 μg + formoterol 9 μg);
• increased sensitivity to budesonide, formoterol or inhaled lactose.

Application in pregnancy and breastfeeding

There is no clinical data on the use of the symbicort of the turbochaler or the combined application of budesonide and formoterol during pregnancy.

During pregnancy, symbiracite should be prescribed only in cases where the expected benefit of therapy for the mother exceeds the potential risk to the fetus. Budesonide should be used in the smallest effective dose required to maintain adequate control of symptoms of bronchial asthma.

It is not known whether Budesonide and Formoterol are highlighted with breast milk in humans. Symbicant Turbukhaler can be appointed to nursing women if the expected benefit of therapy for the mother exceeds the potential risk for the child.

Application in children

Contraindicated B. childhood up to 6 years (for all dosage forms); In childhood up to 12 years old (for dosage form containing budesonide 320 μg + formoterol 9 μg).

Symbicant Turbukhaler 80 / 4.5 μg / dose and 320/9 μg / dose is not intended for the treatment of patients with severe bronchial asthma.

The symbicant Turbukhaler is not intended for the initial selection of therapy in the first stages of the treatment of bronchial asthma.

In case of insufficient effectiveness of therapy or exceeding the maximum recommended doses of symbistort, it is necessary to revise the tactics of treatment. An unexpected and progressive deterioration in the control of symptoms of bronchial asthma or COPD is a potentially threatening condition and requires urgent medical intervention. In this situation, it should be given to the possibility of increasing the dose of GKS, i.e. Purpose of the course of oral GCS or treatment with antibiotics in the case of infection.

Patients are recommended to constantly have drugs with themselves. emergency care, or symbiracort Turbukhaler (for patients with bronchial asthma using a symbicant Turbukhaler for supporting therapy and to relieve attacks), beta2-adrenomimetics of short-acting (for all patients using a symbicant Turbukhaler only for supporting therapy).

The patient's attention should be paid to the need for regular reception of the supporting dose of symbicort in accordance with the selected therapy, even in cases of absence of symptoms of the disease. Inhalation of the symbicort of the Turbukhaler to relieve attacks should be carried out only when symptoms occur, but the use of the drug is not shown for regular preventive use, i.e. before exercise. In such cases, the use of a separate bright action bright action is shown.

If the symptoms of bronchial asthma can be controlled, you can gradually reduce the dose of the symbicort of Turbukhaler, while it is important to constantly monitor the state of patients. Symbicort Turbukhaler should be prescribed in a minimal effective dose.

Treatment with simbitant should not begin during the period of exacerbation or significant deterioration in the flow of bronchial asthma.

During therapy, the symbicant Turbukhaler can mark the exacerbations and the development of serious unwanted reactions associated with Bronchial Asthma. Patients should continue treatment, but seek medical care in the absence of control over the symptoms of bronchial asthma or in case of deterioration of the state after the start of therapy.

As with any other inhalation therapy, the occurrence of paradoxical bronchospasm with immediate amplification of wheezing after taking the dose of the drug. In this connection, a symbicant Turbukhaler's therapy should be discontinued, revise the tactics of treatment and, if necessary, appoint alternative therapy.

Systematic action can manifest itself when taking any inhaled GCS, especially when taking high doses of drugs for a long period of time. The manifestation of the systemic effect is less likely when carrying out inhalation therapy than when using oral GKS. Possible systemic effects include suppression of adrenal function, growth delay in children and adolescents, a decrease in the mineral density of bone tissue, cataract and glaucoma.

It is recommended to regularly control the growth of children, long-term inhalation GKS. In the case of an established growth delay, the therapy should be revised to reduce the dose of the inhaled GKS. It is necessary to carefully assess the advantage of the benefits of the treatment GKS to possible risk Growth delays. When choosing therapy, it is recommended to consult a children's pulmonologist.

Based on limited research data on long-term GCS reception, it can be assumed that most children and adolescents that receive therapy inhalation budesonide will ultimately achieve normal for adult growth rates. At the same time, a minor (about 1 cm) reported, a short-term growth delay, mainly in the first year of treatment.

Due to potentially possible action Inhalation GKS on the mineral density of bone tissue should be paid to patients receiving the drug in high doses for a long time with the presence of osteoporosis risk factors. Research long use inhaled budesonide in children in the middle daily dose 400 μg (measured dose) or in adults in an average daily dose of 800 μg (measured dose) did not show a noticeable effect on the mineral density of bone tissue. There is no data regarding the action of the drug in high doses on the mineral density of bone tissue.

If there is reason to believe that against the background of the preceding systemic therapy, the GCS was broken by the function of the adrenal glands, precautions should be taken when translating patients for treatment with a symbicant turbuchaler.

The advantages of inhalation therapy budesonide, as a rule, minimize the need to receive oral GCS, however, in patients who cease to therapy with oral GCS, the lack of adrenal function can be maintained for a long time. Patients who in the past needed an emergency reception of high doses of GCS, received long-term treatment of inhalation GCS in high dose, can also be in this risk group. It is necessary to provide additional appointment of GCS during the stress or surgical intervention. It is recommended to instruct the patient about the need to rinse the mouth with water after inhalation in order to prevent the development of the Candidosis of the oral mucosa. It is also necessary to rinse the mouth with water after conducting inhalations to relieve symptoms in the event of the development of the Candidosis of the oral mucosa and pharynx.

Formoterol can cause the adjustment of the Qt interval, so the drug should be cautious to prescribe to patients with an increased Qt interval.

The need to use and the dose of the inhaled GCS in patients with active or inactive forms of pulmonary tuberculosis, fungal, viral or bacterial infections Breath organs.

Should be observed special measures Precautions in patients with unstable bronchial asthma applying brief-acting bronchodulators for removing attacks when aggravating severe bronchial asthma, because The risk of hypokalemia development increases against the background of hypoxia and with other states when the likelihood of the development of symptoms of hypokalemic action increases. In such cases, it is recommended to control the content of serum potassium.

Taking patients with acute bronchial obstruction of formoterol at a dose of 90 μg for 3 hours is safe.

During the treatment period, blood glucose concentration should be monitored in patients suffering from diabetes.

Symbicort Turbukhaler contains lactose (less than 1 mg / dose). Usually, such a quantity does not cause undesirable reactions in patients with lactose intolerance.

Impact on the ability to driving vehicles and control mechanisms

Symbicort Turbukhaler does not affect the ability to drive vehicles and control mechanisms. It can influence the ability to drive vehicles and managing mechanisms when developing side effects.

Medicinal interaction

With a simultaneous intake of ketoconazole in a dose of 200 mg 1 time per day and budesonide in a dose of 3 mg, the concentration of budesonide in a plasma is increased by an average of 6 times. When taking ketoconazole 12 hours after receiving the budesonide, the concentration of the latter in the plasma rises by an average of 3 times. There is no information about such interaction with budesonide during inhalation administration, however, we should expect a noticeable increase in the concentration of the drug in blood plasma. Since there is currently no data for the recording of the selection of doses, the specified combination of drugs should be avoided. If this is not possible, the intervals between the tetokonazole and budesonide techniques must be increased as much as possible. It should also be considered to reduce the dose of budesonide. Other powerful CYP3A4 inhibitors are likely to also significantly increase the content of budesonide in plasma. The purpose of the symbicort of Turbukhaler is not recommended as supportive therapy and to relieve attacks to patients receiving powerful CYP3A4 inhibitors.

Beta-adrenoreceptor blockers can relax or inhibit formoterol action. Symbicort Turbukhaler should not be prescribed simultaneously with beta adrenoblockers (including eye drops), except for cases of extreme necessity.

With the simultaneous use of the symbiracort of the turbuchaler and quinidine, dyspeciramide, procainamide, phenothiazines, antihistamine preparations (thermal), Mao and tricyclic antidepressants inhibitors, it is possible to elongate the Qtc interval and an increase in the risk of ventricular arrhythmias.

In addition, levodopop, levothyroxine, oxytocin and ethanol (alcohol) can reduce the tolerance of the heart muscle to beta2-adreminimetics.

With the simultaneous purpose of the Mao inhibitors, as well as drugs with similar properties (Furazolidon, Zimazbazin), it is possible to increase blood pressure.

There is an increased risk of developing arrhythmia in patients when carrying out general anesthesia drugs of halogenated hydrocarbons against the background of the use of the symbicort of the Turbukhaler.

With simultaneous reception of the symbicitort of Turbukhaler and other beta adrenoreceptor agonists, it is possible to gain side effect Formoterol.

The hypocalemic effect of beta2-adrenomimetics can be enhanced by simultaneously appointing xanthine derivatives, mineral derivatives of GKS and diuretics. Hypokalemia increases the predisposition to the development of arrhythmia in patients taking cardiac glycosides.

There was no interaction of budesonide with other drugs, which are used to treat bronchial asthma.

Analogs of the drug Simbicort

Structural analogues of PO active substance:

• Symbicort Turbukhaler.

Analogs of PO therapeutic effect (Means for the treatment of asthma):

• Astmopent;
• Atrovant;
• Afonilaum;
• Beklason;
• Baclomet Iziheler;
• BenaCort;
• Berlikort;
• Berodal;
• Berotek;
• Brikanil;
• Bronchosan;
• Budesonide;
• Ventolin;
• Hydrocortisone;
• Dexamethasone;
• Diprospan;
• Intal;
• Iphiral;
• Clenbuterol;
• Cortisone;
• Kromogen;
• Cromoglin;
• Xidife;
• Metipred;
• Montelar;
• Oxis turbuchaler;
• Pentamine;
• Platifillin;
• Plebecot;
• Polyoxide;
• PolcorTolon;
• Prednisone;
• Bulvikort;
• Pulmikort Turbukhaler;
• Retrail;
• Salamole;
• Salbouvent;
• Salbutamol;
• Salgim;
• Salmecort;
• Salmeter;
• Serent;
• SERELET;
• Seallide Multidisc;
• Singlex;
• Sphophyllin retard;
• Teotard;
• Theophylline;
• Triumsinolone;
• Flixotide;
• Coleleton;
• Erispal;
• Eufillin;
• Eufilong.

In the absence of analogues of drugs on the active substance, you can follow the links below on the disease, which helps the appropriate drug, and see the analogues on therapeutic effects.

Citation:Avdeev S.N. Combined inhalation drugs - new approach To the treatment of bronchial asthma // RMW. 2001. №21. P. 940.

Pulmonology Research Institute of RF

IN the present time is proved that the most effective drugs for control bronchial Asthma (BA) are inhalation glucocorticosteroids (IGCC). ICCC in recommended doses is well tolerated and considered safe drugs. ICCC is appointed in cases where the need for reception B 2 -Gonists to control symptoms in a patient Ba is more than 3 times a week (Barnes & Godfrey, 1988). According to the recommendations of international conciliation documents (GINA), ICCC is shown to all patients with persistent BA, including at the easy course of the disease (NIH / NHLBI, 1998). Arguments for Early Emergencies ICCC at BA are: 1) Inflammation of the mucous membranes are present even in the earliest stages of Ba; 2) ICCCs are the most effective anti-inflammatory drugs at BA compared to other known means; 3) Cancellation of ICCC in patients with light BA may lead to exacerbation of the disease; 4) ICCC prevents the progressive reduction in functional pulmonary indicators, which occurs in patients with Ba over time (O'Byrne, 1999).

Often, when Ba is not controlled by the appointed ISCC doses, the question arises: should I increase the dose of ICCC or add another drug? From the point of view of ensuring a safe profile of the treatment of therapy, the selection of the minimum possible efficient doses of ICCC in combination with another drug is the most reasonable approach for control BA.

Prerequisites for the use of combined drugs

Prolonged B 2 -Gonists are currently considered the most efficient preparations for combination with ICCC (Barnes P.J., 2001). The scientific substantiation of such a combination follows from the complementary effects of ICCC and B 2 -Gonists. Steroids increase the expression of the gene B 2 -receptor and reduce the potential for the development of the receptor desesessitization, while B 2 -Gonists activate inactive glucocorticoid receptors, making them more sensitive to steroid-dependent activation (Roth et al., 2001). In addition, it may be possible to explain the greater efficiency of the combined ICCC treatment and prolonged B 2 -Gonists compared with the increase in the doses of ICCC may be inhibiting the influence of B 2 -Gonists on stimulants of reduction of smooth muscles of bronchi, on plasma peashing in the lumen of the respiratory tract, on the inflammatory cell inflammation BA exacerbation time, as well as an increase in ICCC deposition in the respiratory tract due to their expansion after inhalation B 2 -Gonists (Pauwels et al., 1997).

Other, even more significant arguments in favor of the combined use of ICCC with prolonged B 2 -Gonists are positive results clinical studies, proven the greater efficiency of the combination of drugs compared with increased igx doses. The high efficiency of Beklomethasone and Salmetterol combinations, fluticazone and salmeterol (Shrewsbury et al., 2000), budesonide and formoterol are shown (Pauwels et al., 1997).

In a large multicenter study of FACET, which included 852 patients with BA, a comparison was made of the effectiveness of the formoterol combination and budesonide and doubted doses of budesonide. All patients were distributed to 4 groups: 1) budesonide at a dose of 400 μg / day; 2) budesonide at a dose of 400 μg / day plus formoterol 24 μg / day; 3) budesonide at a dose of 800 μg / day; 4) Budesonide at a dose of 800 μg / day plus formoterol 24 μg / day (Pauwels et al., 1997). In patients who took the combination of drugs, a more significant improvement in day and night symptoms was observed, increasing the volume of the forced exhalation in 1 second (FEV 1) and the peak feed rate (PSV) (Fig. 1). The number of heavy and easy exacerbations of BA was reduced against the background of a high dose of budesonide by 49 and 37%, against the background of receiving low doses of budesonide and formoterol, respectively, by 26 and 40%, but the greatest aggravation demolition was observed in patients who took high doses of budesonide and FORMOTEROL (63 and 62%). Thus, the addition of formyrelol both to high and low doses of Budesonida made it possible to provide the best control of the flow of Ba compared to the monotherapy of Budesonide. Facet study also showed that combination therapy leads to improved quality of life of patients (Juniper et al., 1999).

Fig. 1. Dynamics of FEV1 with various treatment regimens

Despite the encouraging results of clinical studies, there was a fear that the combination of low ICCC doses with prolonged B 2 -Gonists has a smaller effect on inflammation compared to high ICCC doses, and the best functional indicators are achieved due to the addition bronchodilation caused by B 2-identities. Direct evidence of the lack of "masking" inflammation of the respiratory tract against the background of combination therapy was recently confirmed by the data of morphological studies. In a randomized controlled study of KIPS et al. A comparison was made of the effect of two schemes of therapy on inflammatory wet spray markers in 60 patients middle severity. Patients for 1 year were obtained either budesonide at a dose of 800 μg per day, either budesonide 200 μg per day plus formoterol 24 mg per day. Both therapy modes effectively reduced the amount of eosinophils, EG2 (+) cells and the level of eosinophilic cationic protein; The patients also did not differ significantly in the frequency of exacerbations of Ba.

High efficiency with combination therapy B 2 -Gonists of long-term prior action with ICCC served as a prerequisite for the creation of combined drugs, the example of which is the drug symbicort Turbukhaler (budesonide 160 μg + formyurol 4.5 μg).

Symbicort Turbukhaler

One of the main advantages of the drug Simbicort Turbukhaler is the possibility of flexible adaptation of the dose of the drug (the number of techniques and the number of doses of the drug), depending on the severity of the symptoms and the flow of BA. As an initial dose of the drug to achieve control Ba, two inhalations are appointed (dose 160 / 4.5 μg) twice a day (SHAW & JACKSON, 2001). After improving the symptoms of Ba, there is a transition to one inhalation twice a day with the same inhaler or even a single reception of one dose of the drug. With the deterioration of symptoms, for example, during acute respiratory viral infection, Doses of the drug can be increased again without the need to move to a new drug.

A distinctive feature of the combined drug symbicant Turbukhaler is a high development speed therapeutic effectthat, of course, is associated with the properties of formoterol (the beginning of action in 1-3 minutes). In addition, the properties of budesonide (good solubility in the aqueous phase) also provide a quick effect: the effect on functional pulmonary indicators is manifested during the 1st hour, and in inflammatory markers - within 3-5 hours (Le Merre, 1997).

Double blind cross-study Palmquist et al. Compared the speed of the brightness of the bronchying effect of one and two inhalations of the symbicort Turbukhaler 160 / 4.5 μg and one inhalation of the selender Discus 50/250 μg in 13 patients of Ba for the first 3 hours after inhalation. The advantage of both doses of symbicort was noticeably after 3 minutes after inhalation (FEV 1: 2.74 L, 2.75 liters and 2.56 liters, respectively,<0,001) и сохранялось на протяжении 3 часов.

Aerosol delivery device

The effectiveness of inhalation therapy depends not only on the chemical structure of the drug, but also from the device for the delivery of an aerosol into the respiratory tract. The perfect delivery device should ensure the deposition of a large fraction of the drug in the lungs, to be sufficiently easy to use, reliable and affordable for use at any age and with severe forms of the disease. Delivery of the drug in the respiratory tract depends on the set of factors, the most important of which is the size of the particles of the drug aerosol. For inhalation therapy, there are interest of particles to 5 microns - Respiracted particles. As a combination system of Budesonide / Finmoterol, a turbuchaler powder inhaler is used. This delivery system does not use the medium carrier, easy to handle, and, in addition, has two new additions - a dose counter and a more convenient ruined.

Turbukhaler is one of the most effective forms of powder inhalers, ensuring the highest deposition of the drug in the lungs - up to 32% of the measured dose (EDSBACKER, 1999). However, the above results were obtained by budesonide inhalation, while the fraction of the drug delivered to the respiratory tract depends more from the combination of the drug / delivery device than actually from the device itself. When prescribing doses of inhalation preparations, it is very important to take into account such an indicator as the variability of the deposition of drugs, it must be minimal.

Studies conducted in vitro., demonstrated that when using the Inhaler, the Turbuchaler dose of the Budesonide / Formoterol combination did not go beyond the limits of permissible dose variability (Lindblad et al., 2000). In another stand study dedicated to the comparison of the properties of the symbiracort of Turbukhaler and Seretide Discus, it was found that the delivery of respirable particles The symbicort system Turbukhaler reaches 50% compared with 20% from the SERPEY DISCUS system (Granlund et al., 2000).

Comparative efficiency

In the recently published double-blind randomized controlled study for 12 weeks, a comparison was made comparing the effectiveness of the drug symbicort Turbukhaler with a combination of separate preparations of Budesonide (Pulmikort Turbukhaler) and Formoterol (Oxis Turbukhaler) (Zetterstrom et al., 2001). The study was included 362 patients with medium gravity (the average of FEV 1 73.8%), in which the course of the disease was not controlled by the ICCC monotherapy. The patients were randomized in 3 groups of therapy: 1) SymbiCort 160 / 4.5 μg twice a day; 2) 200 μg bulvikort plus oxis twice a day; 3) bulvikort 200 μg twice a day. In the therapy groups, the symbicant and a combination of bulvikort plus oxis was observed a significant improvement in the morning of PSV compared to a group of monotherapy by bulvikort: 35.7 l / min, 32.0 l / min and 0.20 l / min, respectively (p< 0,001) (рис. 2). В первых двух группах было также выявлено достоверное улучшение вечерних показателей ПСВ, снижение числа ингаляций b 2 -агонистов короткого действия. Терапия Симбикортом и комбинацией Пульмикорт плюс Оксис сопровождалась увеличением дней, свободных от симптомов заболевания в среднем на 15% по сравнению с Пульмикортом. Риск развития легких обострений БА также был достоверно ниже в первых двух группах (p<0,01), и время, в течение которого у больных не наблюдалось обострений БА, значительно удлинялось в группах комбинированной терапии (рис. 3). Следует отметить, что улучшение показателей ПСВ и достижение контроля БА достигались быстрее при терапии Симбикортом по сравнению с комбинацией Пульмикорт плюс Оксис, что является аргументом в пользу большей эффективности комбинированного препарата.

Fig. 2. PSV dynamics with various treatment regimens

Fig. 3. The number of patients without exacerbation of BA in various treatment regimens

Despite the proven ECCC effectiveness at Ba, a significant problem is complence, i.e. Commitment of patients follow prescribed therapy. Only about 40% of all sick bars are conscientious of the doctor's appointments (Schmier & Leidy, 1998). The reasons for the poor compliance to therapy are quite diverse, one of them is too complex drug intake mode, therefore the reduction in the number of doses of the drug can improve the compliance, and, consequently, the effectiveness of ICCC therapy. Several studies were conducted, where the effectiveness of the daily dose of ICCCs was compared 1 time per day or in 2-4 reception; Most of these works are devoted to budesonide and its unique ability to bind inside the cage with fatty acids (EDSBACKER, 1999). Conjugated budesonide does not bind to receptors, but remains inside the cell. Over time, under the action of intracellular lipases, budesonide is slowly released and again acquires the ability to interact with receptors, thus providing an extended anti-inflammatory effect. The effectiveness of one-time reception of budesonide was shown in patients with light and moderate severity, both those who have already received ICCC and have earlier ICCC (Shaw & Jackson, 1998; Sampbell, 1999).

Despite the proven ECCC effectiveness at Ba, a significant problem is complence, i.e. Commitment of patients follow prescribed therapy. Only about 40% of all sick bars are conscientious of the doctor's appointments (Schmier & Leidy, 1998). The reasons for the poor compliance to therapy are quite diverse, one of them is too complex drug intake mode, therefore the reduction in the number of doses of the drug can improve the compliance, and, consequently, the effectiveness of ICCC therapy. Several studies were conducted, where the effectiveness of the daily dose of ICCCs was compared 1 time per day or in 2-4 reception; Most of these works are devoted to budesonide and its unique ability to bind inside the cage with fatty acids (EDSBACKER, 1999). Conjugated budesonide does not bind to receptors, but remains inside the cell. Over time, under the action of intracellular lipases, budesonide is slowly released and again acquires the ability to interact with receptors, thus providing an extended anti-inflammatory effect. The effectiveness of one-time reception of budesonide was shown in patients with light and moderate severity, both those who have already received ICCC and have earlier ICCC (Shaw & Jackson, 1998; Sampbell, 1999).

Given the long effect of Formoterol, the question arises about the possibility of a single use of a fixed combination of budesonide / formoterol in patients ba. The use of only one inhaler and only once a day has very large chances to increase the compliance of patients with therapy, and, therefore, its effectiveness.

At the annual Congress of the European Respiratory Society of 2001 in Berlin, the first results of studies dedicated to a single use of symbicant in patients with BA were presented in Berlin. In a double-blind randomized controlled study of Buhl et al., Which included 523 patients with light and medium-free flow, for 12 weeks, a comparison of the treatment with simbitant 160 / 4.5 μg was compared (in the evening), a symbicant 160 / 4.5 μg twice a day and budesonide 200 μg once (Buhl et al., 2001). The one-time use of a symbicant in its effectiveness was not inferior to two-time reception, and exceeded therapy by budesonide in terms of such indicators, as an increase in PSV, FEV 1, receiving short-acting bronchologists (p<0,05). Кроме того, однократный прием Симбикорта снижал риск развития легких обострений БА на 38% по сравнению с будесонидом (р=0,002), повышал число дней, свободных от симптомов БА (р=0,01). В другом, сходном по своему дизайнуисследовании, включавшем 616 больных БА легкого и среднетяжелого течения, были получены примерно такие же результаты: однократное использование Симбикорта по сравнению с будесонидом более эффективно контролировало такие показатели, как ПСВ и ОФВ 1 , число дней, свободных от симптомов БА и потребность в бронхолитиках короткого действия (Kuna et al., 2001). Таким образом, на основании результатов данных исследований можно сделать выводы о хорошей эффективности однократного использования Симбикорта при легкой и среднетяжелой БА.

Impact on the quality of life

Compare the effects of therapy with a symbicant and a combination of bulvikort plus oxis on the quality of life was devoted to the study of Rosental et al. (2001), which included 586 patients ba. Patients for 6 months were obtained either a symbicort of 160 / 4.5 μg two times a day, or a combination of bulvikort 200 μg plus oxis 4.5 μg twice a day. The quality of life, rated on the MINI ASTHMA Quality of Life Questionnaire, has risen in both patients (from 5.32 to 5.87 and from 5.42 to 5.80 points, respectively), Ba control, estimated using Asthma Control Questionnaire Also improved (from 1.58 to 1.08 and from 1.46 to 1.00 points, respectively). Thus, both methods of using combined drugs have approximately the same effect on the quality of life and control Ba.

The ratio "cost-effectiveness"

The studies carried out to date show that the use of combined drugs is more economically more profitable compared to the combination of separate drugs. As part of the Rosental et al. An analysis of direct and indirect costs was carried out with two schemes of therapy with combined drugs. Direct costs (the cost of drugs, the consultation of the doctor, hospitalization, etc.) was significantly lower in the group of patients who took the symbicant, compared with patients who took the combination of bulvikort plus oxis: about $ 91 per patient for 6 months (p \u003d 0.003 ). The indirect costs (disability loss) were also lower in patients who took the symbicort, on average by $ 119 per patient for 6 months.

Safety profile

The safety and tolerance of the composite components of the drug symbicort Turbukhaler - Budesonida and Formoterol - is based on the experience gained during the use of these drugs for 9 billion people-days for Budesonide and 345 million people-days for formoterol. In all the clinical studies dedicated to the symbistort, the number of side effects against the background of the drug was insignificant, and cases of disposal of patients from the study due to the developed complications were extremely rare.

The study of cardiovascular effects when taking high doses of symbi-cortea, a placebo-controlled double blind study Ankerst et al., 2001. During this study, patients received two inhalations of symbicort 160 / 4.5 μg every day, with In one of the days, the patient was prescribed 10 inhalations of symbicorta 160 / 4.5 μg, or placebo, or 4.5 μg oxis. As it turned out, even the purpose of high doses of simbitort did not lead to reliable changes in blood pressure, Qt interval, potassium levels, glucose and blood lactate. It was noted only a slight acceleration of the pulse (5.4 beats per minute compared with placebo). Thus, even if, with a deterioration of symptoms, BA patient will significantly increase the dose of the combined inhaler, this will not entail serious adverse events.

Budesonide + formoterol -

Symbicort Turbukhaler(tradename)

The pulmicort is considered a synthetic glucocorticosteroid preparation, which is effective in bronchial asthma. It is produced in Sweden. Available in suspension for use in inhalations. To conduct them, you need to have a compressor nebulizer, thanks to which the procedure will be more effective. There are an analogues of the bulvikort, with which it is worth a comparison.

The pulmicort is a drug that is used to reduce edema and relieve respiration in patients with laryngospasm. This condition requires urgent medical care.

Instructions for use

The active substance of the drug - budesonide. It is a glucocorticoid, which, when administered through the inhaler, is quickly absorbed. Maximum concentrations are marked after 15-45 minutes. The substance has a strong anti-inflammatory and anti-allergic effect. Thanks to him, the following processes occur:

• Reduced swelling of mucous bronchi;
• Reduced mucus release;
• Reduced hyperreactivity of respiratory tract;
• Symptoms and frequency of diseases of disease decreases.

As practice has shown, a bulvikort with an active substance of budesonide, is normally transferred even with a debt treatment. It does not affect water-electrolyte exchange. Side effects occur very rarely. The medicinal substance is displayed with urine and bile.

Due to the administration of the drug by inhalation, budesonide penetrates both in the upper and long departments of the bronchial tree. Due to this, the swelling of the subclusive layer is reduced. Local use does not give systematic exposure, therefore the risk of side effects is reduced.

The doctor prescribes the drug or an analogue of the bulvikort in the pathologies of the respiratory system with different etiology:

• Bronchial asthma;
• Chronic and acute rhinitis;
• Chronic obstructive pulmonary disease;
• Lung emphysema;
• Infectious diseases of the respiratory organs;
• Cough of any origin.

If applying analogs or in the original bulvikort, the risk of adverse reactions is minimal. The active substance is absorbed quickly and practically does not penetrate the blood. The medicine is excreted with urine.

To apply the drug for inhalations, you can buy it in a special container, where a double dose contains. In packing 5 containers, which are enough for ten inhalations.

If the drug is entered through a nebulizer, then it must be compressor type. Before conducting the procedure, a doctor consultation is required. The dosage is prescribed to each patient individually.

When conducting the procedure, the child is enough 0.5 mg. per day. But in some cases it is necessary to increase the dosage of up to 2 mg.

1. After taking a certain amount of drug, the substance is divorced in the ratio of 1: 1 and flows into the nebulizer.
2. Treatment should occur until the solution is completely extended.
3. Duration - from seven to ten minutes. Then you need to rinse your mouth.

Acute form implies the duration of the course - 3 days, and if it is chronic - therapy is extended to two weeks or more.

Among contraindications:

• Rembossing of the active substance
• Age up to six months

Side phenomena - candidiasis in the oral cavity, allocating, headache, cough, hoarse in voice, excitability, or, on the contrary, depression.

The cost of the drug is about 1000 rubles per 20 doses and approximately 1,400 rubles per 20 doses, but with an increased content of the active ingredient. For funds that differ in the mechanism of action, prices can be very different. For example, salbutamol in the form of an aerosol will cost 100 rubles, and the selender costs about 2000 rubles.

Analogs

Despite this uniqueness of the drug, like others, there are analogues. The fact is that the original is quite expensive, so you have to look for a replacement. For example, it may be a Benacurort, blessing sky, Apulein, Banakap, etc. In all one active ingredient - budesonide.

Benacort has the same action as a bulvikort, but no longer five days treatment continues, it can be used only from sixteen years.

Budenit Sherry Sky has the same action, but it is allowed to use in children from six months. The doctor must determine the desired dosage.

Ventlin is a drug that does not contain budesonide. His active substance is Salbutamol. The dosage is appointed by a specialist. Contraindication - pregnancy, intolerance of components and age up to two years. If you do not consult a doctor regarding the application, you can provoke the appearance of unwanted complications.

Analogs for conducting inhalations

There are an analogues of the bulvikort, which are used for inhalations - Budesonide, Taphneus Novolaizer, BenaCort, Novopulmon E Novolaizer and symbicort Turbukhaler. All of them are good substitutes and can be applied with the permission of the doctor with the same testimony. The dosage is selected individually.

The cheapest option from the listed is Benacurort. It is produced in different forms - powder, suspension, solution and capsules with powder.

Comparing the bulvikort with budesonide worth emphasizing that this is the same drug. The second is produced in the form of a powder for inhalation, one packaging is enough for 200 doses. Each of these contains 200 μg of budesonide and monohydrate lactose up to 8 mg.

If you compare the bulvikort and other analogs, for example, Berodal, it is important to know - they are usually combined in the treatment to achieve a better result. They have different mechanisms actions. Berodual has a bronchology effect, relaxes the smooth muscles of the bronchi, relieves inflammation.

To eliminate the attack of bronchial asthma or cereals in childhood, it suffices to take advantage of one of the listed drugs. But it is important to know that the croup is a basis for hospitalization.

In the case of children, it is necessary to show attentiveness - if two or three procedures do not have an action, it is worth calling an ambulance and report on the occurrence of the doctor. If it is not possible to purchase a nebulizer, bulvikort and its analogues must be present in the first-aid kit.