Symbicort turbuhaler powder for inhalation 320mkg 9mkg 60 doses
Condition: New product
1000 Items
Rating:
Be the first to write a review!
More info
Active ingredients
Budesonide + Formoterol
Release form
Powder
Composition
Micronized budesonide 320 mcgformoterol fumarate dihydrate 9 mcg Auxiliary substances: lactose monohydrate - 491 mcg.
Pharmacological effect
Combined medication for the treatment of bronchial asthma. Contains formoterol and budesonide, which have different mechanisms of action and exhibit an additive effect in reducing the frequency of exacerbations of asthma. The special properties of budesonide and formoterol make it possible to use their combination at the same time as maintenance therapy and for relief of attacks, or as maintenance therapy for bronchial asthma. the severity of symptoms and the frequency of exacerbations of bronchial asthma. With the appointment of budesonide in the form of inhalation, there is a lower incidence of serious adverse effects than with the use of systemic corticosteroids. Reduces the severity of bronchial mucosal edema, mucus production, sputum formation and airway hyperreactivity. The exact mechanism of the anti-inflammatory action of corticosteroids is unknown. Formoterol is a selective β2-adrenoreceptor agonist. After inhalation causes a rapid and long-lasting relaxation of the smooth muscles of the bronchi in patients with reversible airway obstruction. Bronchodilatory effect is dose-dependent, occurs within 1-3 minutes after inhalation and lasts for at least 12 hours after taking a single dose. Symbicort; Turbuchaler ;: budesonide + formoterol Bronchial asthma Clinical efficacy of Symbicort as maintenance therapy. With the combined use of formoterol and budesonide, symptoms of bronchial asthma decrease, lung function improves, and the frequency of exacerbations of the disease decreases. budesonide. In all cases, a short-acting beta2-adrenostimulator was used to relieve seizures. There was no decrease in anti-asthma effect over time.The drug is well tolerated. Against the background of receiving Symbicort Turbuhaler as maintenance therapy for 12 weeks, children aged 6 to 11 years (two inhalations of 80 / 4.5 μg / inhalation 2 times / day) improved lung function and good tolerability was noted drug, compared with the corresponding dose of budesonide turbuhaler. Clinical efficacy of Symbicort as maintenance therapy and for relief of seizures. During the observation of 4447 patients receiving Symbicort therapy as and for relief of seizures for 6 to 12 months, there was a statistically and clinically significant decrease in the number of severe exacerbations, an increase in the period before the onset of the first exacerbation compared with the combination of Symbicort or budesonide as a maintenance therapy and beta2-adrenostimulyator for relief of seizures. Effective control over the symptoms of the disease, pulmonary function, and a decrease in the frequency of inhalations for the relief of seizures was also noted. There was no development of tolerance to the prescribed therapy. In patients who applied for medical aid in connection with the development of an acute attack of bronchial asthma, after inhalation of Symbicort, relief of symptoms (withdrawal of bronchospasm) occurred as quickly and effectively as after administration of salbutamol and formoterol. COPD patients with severe COPD (FEV1 = 36% before therapy Symbicort) on the background of taking the drug Symbicort; Turbuhaler; there was a significant decrease in the frequency of exacerbations of the disease compared with patients who received only formoterol or placebo as therapy (the average frequency of exacerbations was 1.4 compared to 1.8-1.9 in the placebo / formoterol group). There were no differences between taking Symbicort Turbuhaler and formoterol with respect to FEV1 values.
Pharmacokinetics
Suction Symbicort; Turbuhaler; bioequivalent to the corresponding monopreparations (budesonide and formoterol) in relation to their systemic action. Despite this, there was a slight increase in suppression of cortisol after taking Symbicort Turbuhaler compared with monopreparations. This difference does not affect clinical safety. There is no evidence for the pharmacokinetic interaction of budesonide and formoterol.The pharmacokinetic parameters of budesonide and formoterol were comparable after they were taken as monopreparations and as part of Symbicort Turbuhalera. When using the combined drug AUC, budesonide was slightly larger, the absorption of the drug was faster and the Cmax value was higher; Cmax of formoterol coincided with that for a single product. Inhaled budesonide is rapidly absorbed and reaches Cmax after 30 minutes. The average dose of budesonide in the lungs after inhalation through a turbuhaler is 32-44% of the delivered dose. Systemic bioavailability is approximately 49% of the delivered dose. In children aged 6 to 16 years, the average dose of budesonide that entered the lungs after inhalation through a turbuhaler does not differ from that of adult patients (the final concentration of the drug in the blood plasma was not determined). The inhalable formoterol is rapidly absorbed and reaches Cmax after 10 min after inhalation. Studies have shown that the average dose of formoterol, which entered the lungs after inhalation through a turbuhaler, is 28-49% of the delivered dose. Systemic bioavailability - about 61% of the delivered dose. Distribution: Budesonide plasma protein binding is about 90%, formoterol - 50%. Bucodonide Vd is about 3 l / kg, formoterol - 4 l / kg. MetabolismBudesonide is subjected to intensive biotransformation (about 90%) during the first passage through the liver with the formation of metabolites with low glucocorticoid activity. Metabolism of budesonide is carried out mainly with the participation of the CYP3A4 enzyme. The glucocorticoid activity of the major metabolites, 6-β-hydroxybudonesonide and 16-α-hydroxyprednisolone, does not exceed 1% of the similar activity of budesonide. Formoterol is metabolized mainly in the liver by conjugation to form active O-demethylated metabolites, mainly as inactivated conjugates. There is evidence of metabolic interactions or substitution reactions between budesonide and formoterol. ExcretionBudesonide is excreted in the urine as metabolites or in the form of conjugates and only slightly to lichestve - unchanged. Budesonide has a high systemic clearance (approximately 1.2 l / min). After inhalation, 8–13% of the delivered dose of formoterol is excreted unchanged in the urine.Formoterol has a high systemic clearance (approximately 1.4 l / min); T1 / 2 averages 17 hours. The pharmacokinetics in special clinical situations. The pharmacokinetics of formoterol in children and in patients with renal insufficiency has not been studied. The concentration of budesonide and formoterol in the blood plasma may increase in patients with liver disease.
Indications
- bronchial asthma (insufficiently controlled by the use of inhaled GCS and short-acting beta2-adrenomimetics as on-demand therapy, or adequately controlled by inhaled GCS and long-acting β2-adrenomimetics). Symbicort; Turbuhaler; 80 / 4.5 mcg / dose and 160 / 4.5 mcg / dose can be used as maintenance therapy and to relieve seizures; COPD (symptomatic therapy in patients with severe COPD (FEV less than 50% of the estimated estimated level) and with repeated exacerbations in history, the presence of severe symptoms of the disease, despite therapy with long-acting bronchodilators).
Contraindications
- children's age up to 6 years (for all dosage forms); - children's age up to 12 years (for the dosage form containing budesonide 320 mcg + formoterol 9 mcg); - hypersensitivity to budesonide, formoterol or inhaled lactose.With care should be used Symbicort ; Turbuhaler; in patients with pulmonary tuberculosis (active or inactive forms), with fungal, viral or bacterial infections of the respiratory system, in patients with thyrotoxicosis, pheochromocytoma, diabetes mellitus, uncontrolled hypokalemia, idiopathic hypertrophic subaortic stenosis, severe arterial hypertension, idiopathic syndrome, or by a non-optician; cardiovascular diseases (ischemic heart disease, tachyarrhythmia, or severe heart failure), with a prolonged QT interval (formoterol may cause prolonged QTc interval).
Precautionary measures
During treatment, psoriasis may worsen. During pheochromocytoma, propranolol can only be used after taking an alpha blocker. After a long course of treatment, propranolol should be discontinued gradually, under the supervision of a physician. during anesthesia, you must stop taking propranolol or find a remedy for anesthesia with minimal negative inotropic effects.The impact on the ability to drive vehicles and control mechanisms of patients whose activities require increased attention, the question of the use of propranolol on an outpatient basis should be addressed only after evaluating the individual response of the patient.
Use during pregnancy and lactation
There are no clinical data on the use of Symbicort Turbuhaler or the combined use of budesonide and formoterol in pregnancy. In pregnancy, Symbicort; Turbuhaler; should be prescribed only in cases where the expected benefit of therapy for the mother outweighs the potential risk to the fetus. It is necessary to use budesonide in the smallest effective dose necessary to maintain adequate control of symptoms of bronchial asthma. It is not known whether budesonide and formoterol are excreted in human breast milk. Symbicort; Turbuhaler; may be prescribed to nursing women if the expected benefit to the mother is greater than the potential risk to the baby.
Dosage and administration
Symbicort; Turbuhaler; not intended for the initial treatment of bronchial asthma intermittent and mild persistent course. Selection of the dose of drugs that are part of Symbicort Turbuhaler, is carried out individually and depending on the severity of the disease. This should be taken into account not only at the start of treatment with the combined drugs, but also when changing the dose of the drug. In the event that individual patients require a different combination of doses of active substances than in Symbicort; Turbuhaler ;, should be assigned separately beta2-adrenomimetics and / or GCS in separate inhalers. Bronchial asthmaSymbicort; Turbuhaler; 80 / 4.5 mcg / dose and 160 / 4.5 mcg / dose Patients should be under the constant supervision of a physician for adequate selection of the dose of Symbicort Turbuhaler. The dose should be reduced to the lowest, against which the optimal control of the symptoms of bronchial asthma is maintained. When achieving complete control over the symptoms of bronchial asthma on the background of the minimum recommended dose of the drug, at the next stage, you can try the appointment of monotherapy with inhaled GCS. Turbuhaler; assigned for ongoing maintenance therapy in combination with individualshort-acting beta2-adrenostimulyator for relief of attacks; - as maintenance therapy and for relief of attacks Symbicort; Turbuhaler; it is prescribed both for continuous maintenance therapy and on demand when symptoms appear. As a maintenance therapy, the Patient should always have a separate inhaler with a short-acting beta2-stimulant to stop the attacks. Adult (18 years and older) are prescribed Symbicort; Turbuhaler; 80 / 4.5 mcg / dose and 160 / 4.5 mcg / dose 1-2 inhalations 2 times / day. If necessary, you can increase the dose to 4 inhalations 2 times / day. Teenagers (12-17 years) are prescribed Symbicort; Turbuhaler; 80 / 4.5 mcg / dose and 160 / 4.5 mcg / dose 1-2 inhalations 2 times / day. Symbioc is prescribed to children over the age of 6 years; Turbuhaler; 80 / 4.5 mcg / dose 1-2 inhalations 2 times / day. After achieving optimal control of symptoms of bronchial asthma while taking the drug 2 times / day, it is recommended to titrate the dose to the lowest effective, up to the reception 1 time / day, in those cases when, in the opinion of the physician, the patient requires maintenance therapy in combination with long-acting bronchodilators. An increase in the frequency of use of short-acting beta2-adrenostimulants is an indicator of deterioration in the overall control of the disease and requires revision of anti-asthma oh terapii.V as maintenance therapy and cupping pristupovPatsientu you must always carry Symbicort; Turbuhaler; for the relief of seizures. In this case, the drug is especially indicated for patients with insufficient control over bronchial asthma and the need for frequent use of drugs for the relief of seizures; with indications of a history of asthma exacerbations requiring medical intervention. It is necessary to carefully monitor the occurrence of dose-dependent side effects in patients who use a large number of inhalations to relieve seizures. Symbolic is prescribed for adults (18 years and older); Turbuhaler; 80 / 4.5 mcg / dose and 160 / 4.5 mcg / dose; The recommended dose is 2 inhalations per day: 1 inhalation in the morning and evening, or 2 inhalations 1 time per day only in the morning or only in the evening. Some patients may be prescribed a maintenance dose of Symbicort; Turbuhaler; 160 / 4.5 mcg / dose 2 inhalation 2 times / day.If symptoms occur, 1 additional inhalation is necessary. With further increase of symptoms within a few minutes, another 1 additional inhalation is prescribed, but not more than 6 inhalations to relieve 1 attack. Usually no more than 8 inhalations per day are required, however, the number of inhalations can be increased to 12 per day for a short time. In patients who use more than 8 inhalations per day, a review of therapy is recommended. Symbicort; Turbuhaler; 80 / 4.5 mcg / dose and 160 / 4.5 mcg / dose as maintenance therapy and for the relief of seizures is not recommended for children and adolescents under the age of 18 years. Symbicort; Turbuhaler; 320/9 mcg / dose For adults (18 years and older), the drug is prescribed in 1 inhalation 2 times / day. If necessary, you can increase the dose to 2 inhalations 2 times / day. After achieving optimal control of the symptoms of bronchial asthma while taking the drug 2 times / day, it is recommended to titrate the dose to the lowest effective, up to the reception 1 time / day. Adolescents aged 12-17 years old are prescribed 1 inhalation 2 times / day. Symbicort; Turbuhaler; 320/9 mcg / dose is not recommended for children under the age of 12 years due to the lack of clinical data. Patients should regularly visit the doctor to control the optimal dose of the drug. The dose should be reduced to the lowest, against which the optimal control of the symptoms of bronchial asthma is maintained. After achieving optimal control of the symptoms of bronchial asthma while taking the drug 2 times / day, it is recommended to titrate the dose to the lowest effective, up to 1 time / day, in cases where, according to the doctor, supportive therapy is required in combination with long-acting bronchodilators. appoint Symbicort; Turbuhaler; 160 / 4.5 mcg / dose, 2 inhalations, 2 times / day or Symbicort; Turbuhaler; 320/9 mcg / dose of 1 inhalation, 2 times / 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 Symbicort Turbuhaler in patients with renal or hepatic insufficiency. Since budesonide and formoterol are excreted mainly with the participation of hepatic metabolism, then in patients with severe cirrhosis, a slowing down of the rate of excretion of the drug can be expected. The rules for using a turbuchalerair flows carry the medicinal substance into the respiratory tract. Patient must be instructed: - carefully study the Instructions for use of the turbuhaler; - breathe heavily and deeply through the mouthpiece to ensure that the optimal dose of the drug gets into the lungs; - never exhale through the mouthpiece; - for that To minimize the possibility of developing a fungal infection of the oropharynx, rinse your mouth with water after each inhalation. It is also necessary to rinse your mouth with water after inhalation to relieve symptoms and in case of candidiasis of the oral mucosa and pharynx. The patient may not taste or feel the drug after using a turbuhaler, due to the small amount of the substance being delivered. , allowing to dose and inhale the drug in very small doses. When you inhale, the powder from the turbuhaler is delivered to the lungs, so it is important that the patient inhaled strongly and deeply through the mouthpiece. Before using it for the first time, the turbuhaler should be ready for use: 1. Unscrew and remove the cap.2. Hold the inhaler vertically red with the dispenser down. Do not hold the inhaler by the mouthpiece while turning the dispenser. Turn the dispenser until it stops in one direction, and then also all the way - in the opposite direction. Perform the described procedure twice. Now the inhaler is ready for use, this procedure of preparing the turbuhaler for operation is not required before each use. To receive a single dose, the patient must perform the following procedure: 1. Unscrew and remove the cap.2. Hold the inhaler vertically red with the dispenser down. Do not hold the inhaler by the mouthpiece while turning the dispenser. In order to measure the dose, turn the dispenser until it stops in one direction, and then also all the way - in the opposite direction. A click will be heard during this procedure. Exhale Do not exhale through the mouthpiece. Carefully place the mouthpiece between the teeth, squeeze the lips and inhale strongly and deeply through the mouth. The mouthpiece does not chew or compress teeth. Before exhaling, remove the inhaler from the mouth.6. If inhalation of more than one dose is required, repeat paragraphs. 2-5.7.Close the inhaler with a cap, check that the cap of the inhaler is carefully screwed in ..8. Rinse your mouth with water without swallowing. Do not remove the mouthpiece, because It is attached to an inhaler and cannot be removed. The turbuhaler mouthpiece rotates, but you should not rotate it unnecessarily. Since the amount of powder inhaled is very small, you may not feel the taste of the powder after inhalation. However, absolutely accurate compliance with the instructions ensures inhalation (inhalation) of the required dose of the drug. if the inhaler is loaded more than once, it will still receive one dose of the drug when the patients inhalate. In this case, the dose indicator will show the total number of measured doses. The sound that is heard when the inhaler is shaken is made by a desiccant agent, not a drug substance. or the 120th dose (depending on the total number of doses purchased turbuhaler). The indicator shows an interval of 10 doses, so it does not show every measured (loaded) dose. The turbuhaler delivers the required dose of the drug, even if there are no changes in the dose indicator window. The appearance of a red background in the dose indicator window means that 10 doses of the drug remain in the turbuhaler . When the number 0 appears on a red background in the middle of the dose window, the inhaler should be discarded. It should be noted that even when the indicator window shows the number 0, the dispenser continues to rotate. However, the dose indicator stops recording the number of doses (it stops moving) and the figure 0 remains in the dose window of the inhaler. Cleaning Regularly (once a week), the mouthpiece should be cleaned outside with a dry cloth. Do not use water or other mouthpieces to clean the mouthpiece. Disposal Care should be taken when handling the used inhaler and remember that some amount of the drug may remain inside the inhaler.
Side effects
Against the background of co-administration of two drugs, there was no increase in the incidence of adverse reactions. The most frequent adverse reactions associated with taking the drug,The undesirable side effects, such as tremor and tachycardia, that are pharmacologically expected for beta2-adrenergic mimetics, usually have a moderate severity and disappear several days after the start of treatment. During the use of budesonide in COPD, bruises and pneumonia occurred with a frequency of 10% and 6%, respectively , compared with 4% and 3% in the placebo group (more than 0.001 and more than 0.01, respectively). On the CNS side: often (more than 1/100, less than 1/10) - headache; less often (more than 1/100, less than 1/100) - psychomotor agitation, anxiety, nausea, dizziness, sleep disorders; very rarely (less than 1/10 000) - depression, behavioral disturbances (mainly in children), taste disorders. From the cardiovascular system: often (more than 1/100, less than 1/10) - a feeling of heartbeat; less often (more than 1/100, less than 1/100) - tachycardia; rarely (more than 1/10 000, less than 1/1000) - atrial fibrillation, supraventricular tachycardia, extrasystole; very rarely (less than 1/10 000) - angina, fluctuations in blood pressure. On the side of the musculoskeletal system: often (more than 1/100, less than 1/10) - tremor; less often (more than 1/1000, less than 1/100) - muscle cramps. On the part of the respiratory system: often (more than 1/100, less than 1/10) - candidiasis of the mucous membrane of the mouth and throat, mild irritation in the throat, cough, hoarseness; rarely (more than 1/10 000, less than 1/1000) - bronchospasm. Dermatological reactions: less often (more than 1/1000, less than 1/100) - bruising; rarely (more than 1/10 000, less than 1/1000) - exanthema, itching, dermatitis. Allergic reactions: rarely (more than 1/10 000, less than 1/100) - urticaria, angioedema, anaphylactic reactions. Metabolic disorders: rare (more than / 10 000 , less than 1/1000) - hypokalemia; very rarely (less than 1 / 10,000) - hyperglycemia, symptoms of systemic action of GCS (including adrenal hypofunction). Systemic effects of inhaled GCS can be observed when taking the drug in high doses for a long time. The use of beta2-adrenomimetic can lead to an increase in insulin levels in the blood , free fatty acids, glycerol, ketone derivatives.
Overdose
Symptoms: in acute overdose of budesonide, even in large doses, clinically significant symptoms are not expected. With chronic intake of budesonide in excessive doses, systemic action of corticosteroids, such as hypercorticism and suppression of adrenal function, can manifest itself. For formoterol overdose, tremor, headache,cardiopalmus; in some cases, tachycardia, hyperglycemia, hypokalemia, prolonged QTc interval, arrhythmia, nausea, vomiting were reported. For acute bronchial obstruction, formoterol in a dose of 90 mcg was safe for 3 hours. Treatment: supportive and symptomatic treatment is indicated. cancellation of Symbicort Turbuhaler due to an overdose of formoterol, which is included and the composition of the combined drug, should be considered the appointment of the appropriate GCS.
Interaction with other drugs
With simultaneous ingestion of ketoconazole at a dose of 200 mg 1 time / day and budesonide at a dose of 3 mg, the concentration of budesonide in plasma increases on average 6 times. When taking ketoconazole 12 hours after taking budesonide, the concentration of the latter in plasma increases by an average of 3 times. There is no information about such interaction with budesonide during inhalation, but a noticeable increase in the plasma concentration of the drug should be expected. Since no data are currently available for advice on dose selection, this combination of drugs should be avoided. If this is not possible, the intervals between taking ketoconazole and budesonide should be maximized. The possibility of reducing the dose of budesonide should also be considered. Other potent inhibitors of CYP3A4 may also significantly increase the content of budesonide in plasma. The appointment of Symbicort Turbuchaler is not recommended as a maintenance therapy and for the relief of seizures in patients receiving potent inhibitors of CYP3A4. Β-adrenoreceptor blockers can weaken or inhibit the action of formoterol. Symbicort; Turbuhaler; should not be prescribed simultaneously with beta-blockers (including eye drops), unless absolutely necessary. If Simbicort Turbuhaler and quinidine, disopyramide, procainamide, phenothiazines, antihistamines (terfenadine), MAO inhibitors and tricyclic antidepressants can be used at the same time, they may lengthen increased risk of ventricular arrhythmias. In addition, levodopa, levothyroxine, oxytocin and ethanol can reduce the tolerance of the heart muscle to beta2-adrenomimetics. With the simultaneous appointment of MAO inhibitors,as well as drugs with similar properties (furazolidone, procarbazine), it is possible to increase blood pressure. There is an increased risk of arrhythmias in patients during general anesthesia with halogenated hydrocarbons with the use of Symbic Turbuhaler. side effects of formoterol. The hypopocaliemic effect of beta2-adrenergic mimetics can be enhanced with the simultaneous appointment of xanthine derivatives, mi neral derivatives of GCS and diuretics. Hypokalemia increases the susceptibility to the development of arrhythmias in patients taking cardiac glycosides. Budesonide has not been interacted with other drugs used to treat bronchial asthma.
special instructions
It is recommended to gradually reduce the dose of the drug before discontinuing treatment and it is not recommended to abruptly discontinue therapy. Symbicort; Turbuhaler; 80 / 4.5 mcg / dose and 320/9 mcg / dose is not intended for the treatment of patients with severe bronchial asthma. Symbicort; Turbuhaler; It is not intended for the initial selection of therapy in the early stages of bronchial asthma treatment. In case of insufficient efficacy of therapy or if the maximum recommended doses of Symbicort are exceeded, the treatment tactics should be reviewed. An unexpected and progressive deterioration in the control of symptoms of bronchial asthma or COPD is a potentially life-threatening condition and requires urgent medical intervention. In this situation, you should consider the possibility of increasing the dose of GCS, i.e. prescribing a course of oral corticosteroids or antibiotic treatment in the event of an infection being added. Patients are advised to always carry emergency medications, or Symbicort; Turbuhaler; (for patients with bronchial asthma using Symbicort; Turbuhaler; for maintenance therapy and for relief of attacks), beta2-adrenomimetics of short action (for all patients using Symbicort; Turbuhaler; only for maintenance therapy). The patient’s attention should be paid to the need for regular intake Maintenance dose of Symbicort Turbuhaler in accordance with selected therapy, even in cases of no symptoms of the disease. Inhalation of Symbicort Turbuhaler for relief of seizures should be carried out only when symptoms occur, but the use of the drug is not indicated for regular prophylactic use, i.e.before exercise. In such cases, the use of a separate short-acting bronchodilator is indicated. If the symptoms of asthma are manageable, you can gradually reduce the dose of Symbicort Turbuhaler, while it is important to constantly monitor the condition of the patients. Symbicort; Turbuhaler; It should be prescribed in the minimum effective dose. Treatment with Symbicort Turbuhaler should not begin during the period of exacerbation or significant deterioration in the course of bronchial asthma. Patients should continue treatment, but seek medical help in the absence of control over asthma symptoms or if the condition worsens after starting therapy. As with any other inhalation therapy, paradoxical bronchospasm may occur with an immediate increase in wheezing after taking a dose of the drug. In this connection, you should stop therapy with Symbicort Turbuhaler, review treatment tactics and, if necessary, prescribe alternative therapy. A systemic effect can occur when taking any inhaled GCS, especially when taking high doses of drugs for a long period of time. The manifestation of systemic action is less likely with inhalation therapy than with the use of oral corticosteroids. Possible systemic effects include suppression of adrenal function, growth retardation in children and adolescents, decrease in bone mineral density, cataracts and glaucoma. It is recommended to regularly monitor the growth of children who receive long-term inhaled GCS. In the case of established growth retardation, therapy should be reviewed to reduce the dose of inhaled GCS. It is necessary to carefully evaluate the ratio of the benefits of GCS therapy to the possible risk of growth retardation. When choosing a therapy, it is recommended to consult a pediatric pulmonologist. Based on limited research data on the long-term use of GCS, it can be assumed that most children and adolescents receiving therapy with inhaled budesonide will eventually achieve normal adult growth rates.However, a slight (about 1 cm) short growth retardation was reported, mainly in the first year of treatment. Because of the potentially possible effect of inhaled GCS on bone mineral density, special attention should be paid to patients taking the drug in high doses for a long time. time with the presence of risk factors for osteoporosis. Studies on the long-term use of inhaled budesonide in children at an average daily dose of 400 mcg (metered dose) or in adults at an average daily dose of 800 mcg (metered dose) showed no significant effect on bone mineral density. There are no data on the effects of the drug in high doses on bone mineral density. If there is reason to believe that, against the background of previous systemic treatment of the GCS, the adrenal function was impaired, precautions should be taken when transferring patients to Symbicort Turbuhaler. ,