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Symbicort vs Advair

5/4/2016 2:40:00 AM
Symbicort vs Advair

In this article we decided to find out what drug is better – Symbicort vs Advair Diskus. We will list pros and cons of them.

Inhaled corticosteroids (ICS) are medications that can reduce the number of COPD exacerbations and improve quality of life. In COPD, ICS, usually used together with beta2-agonists long acting (LABA; LABA). The most common forms of inhaled ICS and LABA combinations are Advair and salmeterol, and Symbicort and formoterol, but also use of Advair furoate once daily LABA together with a new titled vilanterol. A large number of studies have shown the benefit IRS, but corticosteroids may increase the risk of developing pneumonia. In addition to this, may have difficulty in the diagnosis of pneumonia and the severity of pneumonia can be reflected poorly in clinical trials. Therefore, despite the fact that we have at the reviews of inhaled steroids in COPD, we would like to provide an overview exclusively to pneumonia, so that we can examine the existing evidence.

The overall objective of this review is to assess the risk of pneumonia in people with COPD, taking Advair or Symbicort.

How we answer this question about Symbicort vs Advair?

We searched for all trials comparing Symbicort or Advair versus inhaled simulation (placebo), and all trials comparing their use in combination with a LABA (t.e.budesonid / formoterol, Advair propionate / salmeterol, Advair furoate / vilanterol) against only LABA in the same doses. This allowed us to estimate the risk of how ICS when used alone or in combination with a LABA.

What have we found?
We found 43 studies with the inclusion of more than 30,000 people with COPD. The research, which used Advair were more than studies with Symbicort. The men in these studies made a large share (about 69%), and for COPD they are typically classified as heavy. Last search for studies for inclusion in this review was carried out in September of 2013.

We compared each remedy against monitoring and evaluated separately the results of studies that compared ICS versus placebo, and a combination ICS / LABA versus LABA alone. We also had an indirect comparison of Symbicort and Advair based on their effects against placebo to learn whether one drug is safer than another.

Advair increased the number of "severe" pneumonia (requiring hospitalization). For 18 months, more than 18 people per 1000 treated with Advair were hospitalized with pneumonia.

Symbicort has also increased the number of pneumonia is classified as "serious". For the nine months was recorded for 6 hospitalizations more on every 1000 people treated with Symbicort. A lower dose of Symbicort (320 mcg) was associated with less severe pneumonia than the higher dose (640 mg).

In general, a number cmertey using X groups was not larger, compared with the control, and deaths associated with pneumonia, are too infrequent, anyway.

When we compared Advair and Symbicort against each other, the difference between them was not sufficiently distinct to say whether one of them is safer (for pneumonia requiring hospitalization and, in general, the adverse events and deaths). Any risk of pneumonia cases (i.e., less serious cases which could be treated without hospitalization) was higher with Advair than Symbicort.

Evidence for most outcomes were assessed as having a high or moderate quality. With respect to outcomes, with evidence of high quality, it is unlikely that further research will change our confidence in the estimate of the effect, but the average ratings of [moderate quality evidence] reflect some uncertainty in the results. Results Symbicort studies were generally less distinct because These studies included a smaller number of people, and their duration was shorter.
GCI indicated for the prophylactic treatment of asthma, if you need to? 2 agonists of short action occurs more than 1 time per day (see. Table. 4-1). They cause significantly fewer side effects than systemic HA, but can influence in high doses on the adrenal cortex and metabolism in bone tissue (see. Sec. "CC" at Ch. 7). IUC at recommended doses, in contrast to the system, usually do not cause growth retardation in children, but after prolonged treatment is recommended anthropometric control.

GCI should be used regularly to achieve the best effect of asthma symptoms usually become less pronounced to the 3-7 th day of treatment. Beclomethasone, Symbicort, Advair and have about the same efficiency but Advair 2 times their active. If necessary, the simultaneous reception of the GCI with? 2-agonists produce the first inhalation of the latter, which provides better penetration of GCI in the bronchi. Translation patients after long-term treatment with systemic GC at IUC should be performed in the period of remission, gradually reducing the dose.

High doses of IUC prescribed for lack of effectiveness of the standard inhalation therapy. However, it should be remembered that in this case, the possible suppression of the adrenal cortex functions (see. Sec. "GK" in Ch. 7), so patients give 'steroid card' in stressful situations (eg, before surgery) prophylactically administered system GC. They also are sometimes necessary in infection of bronchoconstriction or increased when there is a need for higher doses of drugs and drug delivery is reduced in small caliber bronchi.

With prolonged use at high doses IUC possible development of glaucoma and cataracts. High doses Bey Symbicort and Advair may affect the metabolism of bone tissue (nevertheless increase the risk of osteoporosis have been identified). Given the potential for side effects, GCI should be used in the lowest effective doses. Therefore, if the asthma symptoms are controlled for several weeks, the dose is gradually reduced, warning the patient that the aggravation or decrease PSV need to go back to the previous dose.

Inhalation IUC is preferably carried out using aerosol inhaler with a large volume spacers, especially with the need to introduce large doses. When applied via a spacer misses much of the drug in the lower respiratory tract and not deposited in the mouth (candidiasis occurs much less frequently).

The use of drugs in powder form to means of delivery, breath-activated, especially useful if the patient can not use aerosol inhalers.


Symbicort and Advair, when used alone or in combination with a LABA may increase the risk of developing severe pneumonia requiring hospitalization. Not been shown to affect the chances of dying when compared with no use of ICS. Comparison of the two drugs did not reveal any significant difference in respect of the risk of death or pneumonia. Advair was associated with a higher risk of any pneumonia (ie, cases of pneumonia, which can be treated on an outpatient basis) than Symbicort, but potential differences in the definition used by the relevant pharmaceutical manufacturers have lowered our confidence in these results. These concerns must be balanced with the known use of ICS (for example, reducing the number of exacerbations, improved lung function and quality of life).

Researchers should be aware of the risks associated with Symbicort and Advair and make sure that the pneumonia is diagnosed appropriately in research.