Clinical pharmacologist on budesonide and formoterol fixed dose combination for treating patients with bronchial asthma and chronic obstructive lung disease

In recent years, the incidence rate of bronchial asthma (BA) and chronic obstructive pulmonary disease (COPD) is increasing. This review presents a comparative analysis of clinical administration and cost-effectiveness of a fixed combination of inhaled glucocorticosteroid, budesonide, and selective long-acting beta2-agonist, formoterol. Clinical pharmacologists try to express their point of view on the abovementioned problem. Global Initiative for Asthma (GINA, 2016) and Global Initiative for Chronic Obstruction Lung Disease (GOLD, 2016) provide for a wider indication of this combination of drugs. It is difficult for practitioners to choose a particular drug because of a large number of generics. Criteria of preferences in prescribing such drugs are clinical efficacy, cost-effectiveness, and ease of usability in real clinical practice. The review presents comparative clinical and cost performance, administration details, as well as the evidence base for using budesonide/formoterol fixed combination. The number of available small-scale studies, comparing the clinical performance of various generics, does not allow us to draw definitive conclusions on their use. The authors of the paper prove that the most cost-effective pharmacologic agents, as a rule, have a small evidence base, often have certain disadvantages in administration (complexity of use, especially for the elderly patients and children, and storing temperature restrictions). The search for information on existing clinical trials and the cost-effectiveness of various generics was carried out using ClinicalTrials.gov, PubMed and grls.rosminzdrav.ru databases. The given data make it possible to understand the main differences between budesonide/formoterol combinations registered in Russia. This information can help to make rational decisions while treating patients with BA and COPD, and choosing the most suitable generics for certain groups of patients.