Utility and effectiveness of Symbicort® Turbuhaler® (oral inhalation containing budesonide and formoterol) in a patient with severe asthma after permanent tracheostomy

Kohhei Maeda; Masao Yamaguchi; Hiroyuki Nagase; Nobuhiro Yasuno; Fumio Itagaki; Machiko Watanabe

doi:10.1186/s40780-018-0118-y

Utility and effectiveness of Symbicort® Turbuhaler® (oral inhalation containing budesonide and formoterol) in a patient with severe asthma after permanent tracheostomy

J Pharm Health Care Sci. 2018 Sep 10:4:24. doi: 10.1186/s40780-018-0118-y. eCollection 2018.

Authors

Kohhei Maeda¹, Masao Yamaguchi², Hiroyuki Nagase², Nobuhiro Yasuno¹, Fumio Itagaki^{1

3}, Machiko Watanabe^{1

3}

Affiliations

¹ 1Department of Pharmacy, Teikyo University Hospital, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605 Japan.
² 2Department of Internal Medicine Division of Respiratory Medicine and Allergology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605 Japan.
³ 3Faculty of Pharma Sciences, Teikyo University, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605 Japan.

Abstract

Background: The utility and effectiveness of inhalational asthma therapy in patients with a permanent tracheostomy has not been established. Previously, a few studies reported the use of nebulizer-type inhalers for treating these patients. Symbicort® Turbuhaler® (Symbicort) is an orally inhaled dry powder containing the corticosteroid budesonide and the bronchodilator formoterol. There are no reports describing the successful use of Symbicort in patients with a permanent tracheostomy.

Case presentation: We describe the case of a woman with poorly controlled severe asthma after a permanent tracheostomy. She had developed thyroid cancer with tracheal invasion for which right thyroid lobectomy and tracheal and esophageal resection were performed, with subsequent construction of a permanent tracheostomy. In our case, prior to surgery, asthma control had been improved by adding a bronchodilator-the long-acting muscarinic antagonist tiotropium-and the anti-IgE antibody agent omalizumab to single maintenance and reliever therapy (SMART) using Symbicort; surgery was then performed. After surgery, asthma control worsened as a result of a change from Symbicort to budesonide nebulizer and a tulobuterol patch. In order to resume SMART therapy, an In-Check® inspiratory flow meter was used to measure and assess whether the inspiratory flow rate was sufficient for a dry-powder inhaler. Inhalation guidance was provided. On inhalation with the tracheostomy closed at the same time, the inspiratory flow rate was 43 L/min at the maximum. This was judged to be sufficient for the effect of Symbicort, and thus the inhaler was changed to Symbicort. Asthma symptoms promptly improved, and the patient was subsequently discharged.

Conclusions: The use of Symbicort resulted in improved asthma control in a patient with severe asthma following a permanent tracheostomy. Thus, it is suggested that inhalation powder could be an option for patients with permanent tracheostomy.

Keywords: Dry-powder inhaler; Inhalation guidance; Permanent tracheostomy; SMART; Severe asthma.

Publication types

Case Reports