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Objective: This systematic review examines the published evidence on the pharmacoecomonics of Symbicort. Symbicort is a combination inhaler used in asthma and chronic obstructive pulmonary disease (COPD) that contains budesonide and formoterol. In asthma, Symbicort can be used as fixed or adjustable dose maintenance therapy as well as for both maintenance and reliever therapy (SMART)., Method: A literature search of PubMed was carried out to find all publications on the pharmacoeconomics of Symbicort. Additional studies were searched for in the reference lists of the papers retrieved and by searching tables of contents of relevant journals. A total of 13 studies on Symbicort in asthma and 2 studies on Symbicort in COPD were found., Results: Total costs were lower with Symbicort than with separate inhalers containing budesonide and formoterol. Adjustable dosing maintained control of asthma using less medication and was associated with lower treatment costs than fixed dosing with Symbicort or the combination of fluticasone/salmeterol. SMART improves asthma control, reduces exacerbations and reduces direct and indirect costs compared to fixed maintenance therapy with either Symbicort or fluticasone/salmeterol. In COPD, Symbicort offers clinical advantages over therapy with the monocomponents and these are achieved at little or no extra cost.

Chronic obstructive pulmonary disease (COPD) is associated with important extrapulmonary, or systemic, effects. There is systemic as well as pulmonary inflammation in COPD and this, together with systemic oxidative stress, contributes to their development. Skeletal muscle dysfunction contributes to exercise limitation. There is a loss of muscle mass and a reduction in the proportion of type 1 fibers. Sedentarism, hypoxia, corticosteroid therapy, nutritional depletion and systemic inflammation may contribute to its development. Weight loss is another important effect. It is associated with a worse prognosis, which changes with therapy and may be due to reductions in calorie intake, changes in intermediate metabolism and effects of systemic inflammation. Cardiovascular disease is a frequent cause of death in COPD and coronary artery disease, left ventricular failure and arrhythmias are systemic effects of COPD, as well as comorbidities sharing a common etiology. Exacerbations of COPD may increase the risk of coronary events by increasing the level of systemic inflammation. Osteoporosis is more common in COPD (even after adjusting for corticosteroid usage) and may be due to a combination of inactivity and the effects of systemic inflammation. COPD is also associated with systemic endothelial dysfunction and CNS abnormalities (including depression), which may also be due to the effects of systemic inflammation. These systemic effects respond to COPD treatments, including pulmonary rehabilitation, nutritional supplementation and inhaled corticosteroids, as well as specific drugs, such as bisphosphonates or diuretics. There is growing evidence that novel approaches, such as the use of statins, may also be of value.