What are the differences between the two commonly used inhaled glucocorticoid drugs for the treatment of COPD?

A friend asked Huazi, in the treatment of chronic obstructive pulmonary disease (COPD), there are two commonly used glucocorticoid inhalation drugs, one is budesonide formoterol inhalation powder, and the other is salmeterol fluticasone inhalation powder. The instructions of these two drugs are similar, so what is the difference?

Huazi said that these two drugs are not just simple glucocorticoids, they also contain long-acting β2 receptor agonists, which together form a compound preparation. The main difference between the two is the duration of action.

1. Both are compound preparations composed of two drugs. In the budesonide-formoterol inhalation powder, the glucocorticoid is budesonide, and formoterol is a long-acting β2 receptor agonist.

In salmeterol/fluticasone inhalation powder, the glucocorticoid is fluticasone and salmeterol is a long-acting beta-2 receptor agonist.

Glucocorticoids have a powerful anti-inflammatory effect and can increase the response of airway smooth muscle to β2 receptor agonists; long-acting β2 receptor agonists can relax airway smooth muscle.

The combination of the two can produce a synergistic anti-inflammatory and antiasthmatic effect, and reduce the adverse reactions caused by the use of high-dose glucocorticoids or β2 receptor agonists alone. Both are suitable for the treatment of chronic obstructive pulmonary disease (COPD) and bronchial asthma.

2. What is the difference between the two drugs? The difference between budesonide formoterol inhalation powder and salmeterol fluticasone inhalation powder mainly lies in the duration of action of the drugs.

Budesonide-Formoterol Inhalation Powder:

The peak time of budesonide after inhalation is about 30 minutes, and the half-life of blood concentration is 2 to 3 hours. It has both lipophilic and hydrophilic properties, can easily penetrate the mucus layer in the respiratory tract, has a high deposition rate in the lungs, and can exert a rapid anti-inflammatory effect.

Formoterol takes effect 2 to 5 minutes after inhalation, reaches its peak in 15 minutes, and lasts for 8 to 12 hours.

Salmeterol/fluticasone inhalation powder:

The blood concentration half-life of fluticasone is 10 to 14 hours. It has high lipophilicity and can easily pass through the cell membrane to exert its effects. However, due to its high lipophilicity, it has difficulty penetrating the mucus layer and takes a long time to be absorbed.

Salmeterol takes effect 10 to 20 minutes after inhalation, reaches its peak effect in 2 hours, and lasts for more than 12 hours.

Compared with the two, budesonide-formoterol inhalation powder has a faster effect, and formoterol is the most effective among the current β2 receptor agonists. It has more advantages than salmeterol-fluticasone inhalation powder in preventing acute asthma attacks, and salmeterol-fluticasone inhalation powder has a longer duration of action.

3. The adverse reactions of the two are basically the same. After inhaling glucocorticoids, common adverse reactions include throat irritation, discomfort, oral ulcers, oral fungal infections, dry mouth, cough, hoarseness, etc. Therefore, after using the medicine, you must rinse your mouth carefully to avoid drug powder residue in the mouth.

Usually, inhaled glucocorticoids only act locally in the respiratory tract, with only a very small amount being absorbed and rarely causing systemic adverse reactions. Budesonide has high lung deposition, while the potential adverse reactions of fluticasone absorbed are slightly higher than those of budesonide.

The adverse reactions of the selective β2 receptor agonists in both are basically the same, with common symptoms such as arrhythmia, tremor, headache, hypokalemia, cough, sore throat, nausea, etc. The symptoms are usually mild and can be tolerated.

It should be noted that both are mainly used for the long-term maintenance treatment of COPD and asthma. Budesonide and formoterol inhalation powder can be used to relieve acute asthma attacks, while salmeterol and fluticasone inhalation powder cannot be used for acute asthma attacks.

It is recommended that asthma patients should carry fast-acting bronchodilators, such as salbutamol, terbutaline, etc., to relieve symptoms during acute attacks.

In summary, both budesonide formoterol inhalation powder and salmeterol fluticasone inhalation powder can be used to treat COPD and asthma. The difference between the two is that the former is faster and stronger, while the latter has a longer duration of action. The drug should be selected and used under the guidance of a doctor. If you have any questions about the drug, please consult a doctor or pharmacist. I am pharmacist Huazi, welcome to follow me and share more health knowledge.