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Optimizing the Management of Chronic Obstructive Pulmonary Disease (COPD) ©AstraZeneca LP. All rights reserved. 275086 2/09.

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Presentation on theme: "Optimizing the Management of Chronic Obstructive Pulmonary Disease (COPD) ©AstraZeneca LP. All rights reserved. 275086 2/09."— Presentation transcript:

1 Optimizing the Management of Chronic Obstructive Pulmonary Disease (COPD) ©AstraZeneca LP. All rights reserved. 275086 2/09

2 Top 5 Causes of Death: COPD on the Rise Jemal A et al. JAMA. 2005;294:1255-1259. -52% -3% -63% 103% -41% -80% -60% -40% -20% 0% 20% 40% 60% 80% 100% 120% % Change, 1970-2002 Heart disease CancerStrokeCOPDAccidents

3 Overall Health Care Costs Are Higher in Patients With COPD 19270 3436 2498 969 5888 2720 0 5000 10000 15000 20000 25000 30000 COPD cohort (n=8370) Comparison cohort (n=8370) Mean Health Care Cost per Person (US dollars) Other health-care-related costs* Outpatient costs Hospitalization costs *Included emergency room visits, physician visits, and pharmacy costs. † Each comparator was based on the mean of 3 controls from a data set including 25,110 patients. Menzin J et al. Respir Med. 2008;102:1248-1256.

4 Where Can We Improve COPD Management? COPD remains underdiagnosed 1 Awareness of COPD guidelines suboptimal 2Awareness of COPD guidelines suboptimal 2 Spirometry used inconsistently 2Spirometry used inconsistently 2 Mortality increasing among women 3Mortality increasing among women 3 Present in the fifth decade of life, 4 though early symptoms may be missed 2Present in the fifth decade of life, 4 though early symptoms may be missed 2 Diagnosis and treatment may prevent or delay progression of lung function decline and symptoms 5 Spirometry is key to the diagnosis of COPD 5Spirometry is key to the diagnosis of COPD 5 Education represents an opportunity to improve outcomes for COPD patients 2,5Education represents an opportunity to improve outcomes for COPD patients 2,5 1. Mannino DM et al. MMWR Surveillance Summary. 2002;51:1-16. 2. Yawn BP, Wollan PC. Int J COPD. 2008;3:311-317. 3. Deaths from chronic obstructive pulmonary disease—United States, 2000-2005. MMWR Morb Mortal Wkly Rep. 2008;57:1229-1232. 4. American Association for Respiratory Care. http://www.aarc.org/resources/confronting_copd/exesum.pdf. Accessed February 11, 2009. 5. Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Updated 2008. http://www.goldcopd.com/Guidelineitem.asp?l1=2&l2=1&intId=989. Accessed November 21, 2008. Early diagnosis and treatment may lead to better outcomes 5

5 Overview of COPD Pathophysiology Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Updated 2008. Available at: http://www.goldcopd.com/Guidelineitem.asp?l1=2&l2=1&intId=989. Accessed November 21, 2008. Emphysema Mucociliary Dysfunction Structural Changes Systemic/ Extrapulmonary Effects Exacerbations Oxidative Stress Susceptibility Genes Gender Proteinases/ Cell Mediators Cigarette Smoke Environmental Irritants Respiratory Infections LungInflammation, Hyperinflation, Airway Obstruction, Elastic Recoil Loss Chronic Bronchitis

6 63 85 7 87 80 8 77 88 45 94 98 37 Inflammation Is Present Even in Early Stages of COPD 67 54 25 55 66 33 84 73 29 100 92 32 0 20 40 60 80 100 120 PMNsMacrophagesEosinophils CD4 Cells CD8 Cells B Cells Airways With Measurable Cells (%) Inflammatory Cells GOLD Stage 0 GOLD Stage I GOLD Stages II and III GOLD Stage IV Adapted from Hogg JC et al. N Engl J Med. 2004;350:2645-2653.

7 Airflow Obstruction in COPD Is Partially Reversible Postbronchodilator FEV 1 measured after administration of 80 µg ipratropium and 400 µg albuterol. Adapted with permission from Tashkin DP et al. Eur Resp J. 2008;31:742-750. Change in FEV 1 % 15 10 5 0 Patients, % * -30-25-20-15-10-505101520253035404550556065707580859095100 Degree of Reversibility *65.6% showed a ≥15% increase in FEV 1

8 Spirometry Is Essential for Diagnosing COPD Chronic symptoms = cough, sputum, and/or shortness of breath Exposure to risk factors = tobacco, occupational irritants, and/or indoor/outdoor pollution Spirometry* to confirm COPD diagnosis Spirometry* to confirm COPD diagnosis FEV 1 /FVC <0.70 FEV 1 determines staging FEV 1 /FVC <0.70 FEV 1 determines staging Spirometry* to confirm COPD diagnosis Spirometry* to confirm COPD diagnosis FEV 1 /FVC <0.70 FEV 1 determines staging FEV 1 /FVC <0.70 FEV 1 determines staging If... And... Then... *Additional testing: chest x-ray, echocardiogram, arterial blood gas, sputum analysis, computed tomography (CT) scan. Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Updated 2008. http://www.goldcopd.com/Guidelineitem.asp?l1=2&l2=1&intId=989. Accessed November 21, 2008.

9 Spirometry Is a Useful Tool to Assess COPD Severity and Progression 1,2 1. American Thoracic Society, European Respiratory Society. Standards for the diagnosis and management of patients with COPD. http://www.thoracic.org/sections/copd/. Accessed November 19, 2008. 2. Global Initiative for Chronic Obstructive Lung Disease. Global strategy for diagnosis, management, and prevention of chronic obstructive pulmonary disease. Updated 2008. http://www.goldcopd.com/Guidelineitem.asp?l1=2&l2=1&intId=989. Accessed November 21, 2008. IIIIIIIV  FEV 1 /FVC <0.70  FEV 1 ≥80% predicted  FEV 1 /FVC <0.70  50% ≤ FEV 1 <80% predicted  FEV 1 /FVC <0.70  30% ≤FEV 1 <50% predicted  FEV 1 /FVC <0.70  FEV 1 <30% predicted or FEV 1 <50% predicted plus chronic respiratory failure Chronic cough and sputum production Stage I symptoms + dyspnea Progressive dyspnea Stage III symptoms + respiratory failure, right heart failure, weight loss, arterial hypoxemia Stage Severity Typicalsymptoms

10 Goals of COPD Management COPD management includes both pharmacologic and nonpharmacologic treatment. Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Updated 2008. http://www.goldcopd.com/Guidelineitem.asp?l1=2&l2=1&intId=989. Accessed November 21, 2008. Relieve symptomsRelieve symptoms Minimize side effectsMinimize side effects Improve exercise toleranceImprove exercise tolerance Prevent and treat exacerbations and complicationsPrevent and treat exacerbations and complications Improve health statusImprove health status Prevent disease progressionPrevent disease progression Reduce mortalityReduce mortality Short Term Long Term and

11 Nonpharmacologic Therapy to Manage COPD Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Updated 2008. http://www.goldcopd.com/Guidelineitem.asp?l1=2&l2=1&intId=989. Accessed November 21, 2008. Patient Education Oxygen Therapy Surgical and Non- surgical Alternatives Pulmonary Rehabilitation Smoking Cessation Vaccination

12 Pharmacologic Therapy to Manage COPD Add regular treatment with one or more long-acting bronchodilators (when needed); Add rehabilitation Add inhaled glucocorticosteroids if repeated exacerbations Active reduction of risk factor(s); influenza vaccination Add short-acting bronchodilator (when needed) Add long-term oxygen if chronic respiratory failure; Consider surgery IIIIIIIV Adapted from Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Updated 2008. http://www.goldcopd.com/Guidelineitem.asp?l1=2&l2=1&intId=989. Accessed November 21, 2008.  FEV 1 /FVC <0.70  FEV 1 ≥80% predicted  FEV 1 /FVC <0.70  50% ≤FEV 1 <80% predicted  FEV 1 /FVC <0.70  30% ≤FEV 1 <50% predicted  FEV 1 /FVC <0.70  FEV 1 <30% predicted or FEV 1 <50% predicted plus chronic respiratory failure Stage Severity

13 Symbicort ® (budesonide/formoterol fumarate dihydrate) Inhalation Aerosol for COPD 277761 5/09 SYMBICORT 160/4.5 μg is indicated for the twice-daily maintenance treatment of airflow obstruction in patients with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema Does not replace fast-acting inhalers and should not be used to treat acute symptoms of COPD ©AstraZeneca LP. All rights reserved.

14 SYMBICORT Has Been Extensively Studied in Patients With Moderate to Very Severe COPD *Administered as 2 inhalations BID. † Monocomponents refers to administration of budesonide monotherapy, formoterol monotherapy, and budesonide + formoterol administered in separate devices, all administered as 2 inhalations BID. 1. Rennard SI et al. Drugs. 2009;69:549-565. 2. Tashkin DP et al. Drugs. 2008;68:1975-2000. Study Duration (weeks)NPurpose Was to Compare the Efficacy and Safety of... SUN 1 521964 SYMBICORT pMDI 160/4.5 μg × 2 inhalations BID and SYMBICORT pMDI 80/4.5 μg × 2 inhalations BID versus formoterol* and placebo* SHINE 2 261704 SYMBICORT pMDI 160/4.5 μg × 2 inhalations BID and SYMBICORT pMDI 80/4.5 μg × 2 inhalations BID versus its monocomponents † and placebo* Overview of Key Phase III Studies

15 SUN and SHINE Study Design Features Patients receiving concomitant medications prior to study initiation 1,2Patients receiving concomitant medications prior to study initiation 1,2 –Allowed to remain on ICS during run-in –Long-acting anticholinergics were changed to stable doses of ipratropium during run-in and throughout the study –Long-acting β 2 -agonists (LABAs) were changed to short-acting β 2 -agonists (SABAs) as needed Subjects with underlying comorbidities were included 1,2Subjects with underlying comorbidities were included 1,2 –Hypertension (42%) –Dyslipidemia (22%-24%) –Cardiac disease (18%) –Diabetes (10%-11%) 1. Rennard SI et al. Drugs. 2009;69:549-565. 2. Tashkin DP et al. Drugs. 2008;68:1975-2000.

16 SUN Assessed the Efficacy and Safety of SYMBICORT Over 12 Months in Patients With COPD 1,2 1. Nelson HS et al. Poster 302 presented at: Chest 2008; October 25-30, 2008; Philadelphia, PA. 2. Rennard SI et al. Drugs. 2009;69:549-565. Run-in SYMBICORT pMDI 160/4.5 µg  2 Inhalations BID (n=494) Formoterol DPI 4.5 µg  2 Inhalations BID (n=495) Placebo  2 Inhalations BID (n=481) SYMBICORT pMDI 80/4.5 µg  2 Inhalations BID 56 4613 7 9 8 12 FUVisit Month 1234 -0.5012 Double-blind (n=494) Follow-up RANDOMIZATIONRANDOMIZATION

17 SHINE Assessed Efficacy and Tolerability of SYMBICORT Over 6 Months in Patients With COPD Adapted from Tashkin DP et al. Drugs. 2008;68:1975-2000. Run-in SYMBICORT pMDI 160/4.5 µg  2 Inhalations BID (n=277) Budesonide pMDI 160 µg  2 Inhalations BID (n=275) Placebo  2 Inhalations BID (n=300) SYMBICORT pMDI 80/4.5 µg  2 Inhalations BID (n=281) 56 467 Visit Month 1234 -0.5012 Double-blind Follow-up Budesonide pMDI 160 µg  2 Inhalations BID + Formoterol DPI 4.5 µg 2  Inhalations BID (n=287) Formoterol DPI 4.5 µg  2 Inhalations BID (n=284) RANDOMIZATIONRANDOMIZATION FU

18 COPD Efficacy Variables Included Measures of Stabilization and Bronchodilation 1-3 1. Rennard SI et al. Drugs. 2009;69:549-565. 2. Data on File, 272887, AZPLP. 3. Tashkin DP et al. Drugs. 2008;68:1975-2000. VariableComparisonDemonstrated SYMBICORTVersus Predose FEV 1 160/4.5 µg x 2 inhalations BID and 80/4.5 µg x 2 inhalations BID Formoterol 4.5 µg x 2 inhalations BID (SUN and SHINE) Stabilizing, anti-inflammatory effect, largely contributed by budesonide 1-hour Postdose FEV 1 160/4.5 µg x 2 inhalations BID and 80/4.5 µg x 2 inhalations BID Budesonide 160 µg x 2 inhalations BID (SHINE) and Placebo (SUN) Bronchodilatory effect, largely contributed by formoterol

19 SUN Patient Demographic and Baseline Clinical Characteristics 1,2 Note: mean age was ~63 years and ~64% of subjects were male. *Safety analysis set. † Data were missing for 3 subjects. 1. Rennard SI et al. Drugs. 2009;69:549-565. 2. Data on File, 275389 AZPLP. Treatment Group, Mean SYMBICORT 160/4.5 µg (n=494) SYMBICORT 80/4.5 µg (n=494) Formoterol 4.5 µg (n=495) Placebo (n=481) Total (N=1964) FEV 1, L (SD) 1.02 (0.39) 1.04 (0.39) 1.03 (0.40) 1.08 (0.42) 1.04 (0.40) Predicted FEV 1, % (SD) 33.8 (11.4) 34.5 (11.5) 33.7 (11.3) 35.5 (11.9) 34.4 (11.6) Reversibility ≥12% +  in FEV 1 ≥0.2L, n (%) 150 (30.4) 144 (29.1) 158 (31.9) 153 (31.8) 605 (30.8) Postbronchodilator † Predicted FEV 1, n (%) <30% 120 (24.3) 94 (19.0) 119 (24.0) 90 (18.7) 423 (21.5) ≥30% to <50% 290 (58.7) 314 (63.6) 285 (57.6) 298 (62.0) 1187 (60.4) ≥50% to <80% 84 (17.0) 85 (17.2) 89 (18.0) 91 (18.9) 349 (17.8) ≥80%00 1 (0.2) 2 (0.1)

20 SYMBICORT Significantly Improved Lung Function as Early as Day 1, Which Was Sustained Over 12 Months 1,2 *P<.008 vs FM. (P value based on ANCOVA analysis) AOT = average of the randomized treatment period. 1. Rennard SI et al. Drugs. 2009;69:549-565. 2. Data on File, 272887, AZPLP. Adjusted Mean Change From Baseline (mL) Month AOT -20 0 20 40 60 80 100 120 0123456789101112 SYMBICORT 160/4.5 µg (n=471) Formoterol 4.5 µg (n=465) Placebo (n=436) 140 * SUN: A 12-month Efficacy and Safety Study Predose FEV 1

21 SYMBICORT Rapidly Improved Lung Function Within 5 Minutes of the First and Subsequent Doses Improvement in Serial FEV 1 Within 5 Minutes SYMBICORT 160/4.5 µg x 2 Inhalations BID (n=121) LOCF = last observation carried forward. Data on File, 273071, AZPLP. Mean Percent Change From Baseline in FEV 1 Baseline 0 5 10 15 20 35 25 30 24681012 Hours 15330 Minutes 1 Within 5 Min Postdose SUN: A 12-month Efficacy and Safety Study Maintenance Effect First Dose (day of randomization) Last Dose (end of month 12, LOCF)

22 SUN: A 12-month Efficacy and Safety Study Mean Percent Change From Baseline in FEV 1 Baseline 0 5 10 15 20 35 25 30 Maintenance Effect 24681012 Hours 15330 Minutes 1 First Dose (day of randomization) Last Dose (end of month 12, LOCF) SYMBICORT Rapidly Improved Lung Function Within 5 Minutes of the First and Subsequent Doses Data on File, 273071, AZPLP. Comparator Arms Mean Percent Improvement in 5 Minutes Day of Randomization SYM 160/4.5 µg:17.7% FM: 16.5% Placebo: 1.7% End of Treatment SYM 160/4.5 µg:21.8% FM: 15% Placebo:1.9% Improvement in Serial FEV 1 Within 5 Minutes SYMBICORT 160/4.5 µg x 2 Inhalations BID (n=121) Within 5 Min Postdose

23 SYMBICORT Significantly Reduced Overall Daily COPD Symptoms by 35% Versus Formoterol Over 12 Months Comparison is SYMBICORT 160/4.5 µg x 2 inhalations BID (n=489) versus formoterol 4.5 µg x 2 inhalations BID (n=489). *P=.03. † P=.04. ‡ P=.15. Data on File, 273072, AZPLP. Adjusted Mean Change From Baseline (% Improvement Versus Formoterol) Overall Symptoms* Breathlessness*Cough † Sputum ‡ Symptoms 50 40 20 10 0 35%28%33%42% 30 SUN: A 12-month Efficacy and Safety Study

24 BCSS: A Validated Measure of Common COPD Symptoms The BCSS is a reliable and validated 3-item questionnaireThe BCSS is a reliable and validated 3-item questionnaire –Designed to assess patients’ daily respiratory symptoms –Underwent a rigorous validation process designed by AstraZeneca Patients are asked to record the severity of three common COPD symptoms:Patients are asked to record the severity of three common COPD symptoms: –Breathlessness –Cough –Sputum Symptoms are evaluated on a 5-point Likert-type scale ranging from 0 to 4, with higher scores indicating more severe symptomsSymptoms are evaluated on a 5-point Likert-type scale ranging from 0 to 4, with higher scores indicating more severe symptoms Leidy NK et al. Respir Med. 2003;97(suppl A):S59-S70.

25 SYMBICORT Reduced Total Daily Rescue Medication Use Over 12 Months *P=.019. Data on File, 276830, AZPLP. SYMBICORT 160/4.5 µg x 2 Inhalations BID Formoterol 4.5 µg x 2 Inhalations BID -1.2 -0.8 -0.6 -0.4 -0.2 0 LS Mean Change From Baseline (inhalations/day) (n=490) (n=489) * Total Daily Rescue Medication Use SUN: A 12-month Efficacy and Safety Study

26 SYMBICORT 160/4.5 µg (n=771) % Budesonide 160 µg (n=275) % Formoterol 4.5 µg (n=779) % Placebo (n=781) % COPD-related respiratory events 13.412.417.114.3 Nasopharyngitis7.33.35.84.9 Oral candidiasis 6.04.41.21.8 Bronchitis5.44.74.53.5 Sinusitis3.51.53.11.8 Viral upper respiratory tract infection 3.51.83.62.7 Pneumonia2.31.82.63.3 Represents pooled data from both SUN and SHINE studies, at a dose of 2 inhalations BID. Data on File, 273073, AZPLP. Adverse Event Profile for SYMBICORT Adverse Events Reported by ≥3% of Subjects in Any Treatment Group

27 Other Safety Findings for SYMBICORT in COPD Vital signsVital signs Physical examinationPhysical examination ECGECG 24-hour urinary cortisol24-hour urinary cortisol Bone mineral density*Bone mineral density* Lenticular opacities and intraocular pressure*Lenticular opacities and intraocular pressure* *As reported in SUN only. 1. Rennard SI et al. Poster 308 presented at: Chest 2008; October 25-30, 2008; Philadelphia, PA.. 2. Tashkin DP et al. Drugs. 2008;68:1975-2000. 3. Rennard SI et al. Drugs. 2009;69:549-565. No Clinically Important Differences Between SYMBICORT pMDI 160/4.5 µg and Placebo Were Observed in the Following Parameters 1-3

28 SYMBICORT: Important Safety Information Particular care is needed for patients being transferred from systemically active corticosteroids to inhaled corticosteroidsParticular care is needed for patients being transferred from systemically active corticosteroids to inhaled corticosteroids Patients who are receiving SYMBICORT should not use additional formoterol or other long-acting inhaled beta 2 -agonists for any reasonPatients who are receiving SYMBICORT should not use additional formoterol or other long-acting inhaled beta 2 -agonists for any reason Lower respiratory tract infections, including pneumonia, have been reported following the inhaled administration of corticosteroids, including budesonide, a component of SYMBICORTLower respiratory tract infections, including pneumonia, have been reported following the inhaled administration of corticosteroids, including budesonide, a component of SYMBICORT Long-term use of orally inhaled corticosteroids, such as budesonide, a component of SYMBICORT, may affect normal bone metabolism resulting in a loss of bone mineral densityLong-term use of orally inhaled corticosteroids, such as budesonide, a component of SYMBICORT, may affect normal bone metabolism resulting in a loss of bone mineral density Glaucoma, increased intraocular pressure, and cataracts have been reported in patients following the long-term administration of inhaled corticosteroids, including budesonide, a component of SYMBICORTGlaucoma, increased intraocular pressure, and cataracts have been reported in patients following the long-term administration of inhaled corticosteroids, including budesonide, a component of SYMBICORT Caution should be exercised when considering the coadministration of SYMBICORT with long-term ketoconazole and other known potent CYP3A4 inhibitorsCaution should be exercised when considering the coadministration of SYMBICORT with long-term ketoconazole and other known potent CYP3A4 inhibitors SYMBICORT should be administered with caution in patients being treated with MAO inhibitors or tricyclic antidepressants, or within 2 weeks of discontinuation of such agentsSYMBICORT should be administered with caution in patients being treated with MAO inhibitors or tricyclic antidepressants, or within 2 weeks of discontinuation of such agents WARNING: Long-acting beta 2 -adrenergic agonists may increase the risk of asthma-related death. Therefore, when treating patients with asthma, SYMBICORT should only be used for patients with asthma not adequately controlled on other asthma-controller medications (eg, low- to medium-dose inhaled corticosteroids) or whose disease severity clearly warrants initiation of treatment with 2 maintenance therapies. Data from a large placebo-controlled US study that compared the safety of another long-acting beta 2 -adrenergic agonist (salmeterol) or placebo added to usual asthma therapy showed an increase in asthma-related deaths in patients receiving salmeterol. This finding with salmeterol may apply to formoterol (a long-acting beta 2 -adrenergic agonist), one of the active ingredients in SYMBICORT (see WARNINGS in full Prescribing Information)WARNING: Long-acting beta 2 -adrenergic agonists may increase the risk of asthma-related death. Therefore, when treating patients with asthma, SYMBICORT should only be used for patients with asthma not adequately controlled on other asthma-controller medications (eg, low- to medium-dose inhaled corticosteroids) or whose disease severity clearly warrants initiation of treatment with 2 maintenance therapies. Data from a large placebo-controlled US study that compared the safety of another long-acting beta 2 -adrenergic agonist (salmeterol) or placebo added to usual asthma therapy showed an increase in asthma-related deaths in patients receiving salmeterol. This finding with salmeterol may apply to formoterol (a long-acting beta 2 -adrenergic agonist), one of the active ingredients in SYMBICORT (see WARNINGS in full Prescribing Information)

29 Approved Dosage for Patients With COPD *Administered in the morning and in the evening. SYMBICORT [package insert]. Wilmington, DE: AstraZeneca LP. SYMBICORT 160/4.5 μg is indicated for the twice-daily maintenance treatment of airflow obstruction in patients with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema SYMBICORT is not a rescue medication and does NOT replace fast-acting inhalers 160/4.5 µg, 2 inhalations twice daily*

30 Rapid Improvement in Lung Function and Long-lasting Control* With SYMBICORT Can Help Patients Do More SYMBICORT significantly improved lung function as early as day 1, which was sustained over 12 months 1SYMBICORT significantly improved lung function as early as day 1, which was sustained over 12 months 1 SYMBICORT rapidly improved lung function within 5 minutes † of the first and subsequent doses 2SYMBICORT rapidly improved lung function within 5 minutes † of the first and subsequent doses 2 SYMBICORT significantly reduced overall daily COPD symptoms by 35% vs formoterol over 12 months 3SYMBICORT significantly reduced overall daily COPD symptoms by 35% vs formoterol over 12 months 3 *In a 12-month clinical study, SYMBICORT improved predose FEV 1, 1-hour postdose FEV 1, serial FEV 1 (to measure onset of effect), AM and PM peak expiratory flow (PEF), and reduced COPD symptoms and rescue albuterol use. † Significant bronchodilation (>15% improvement in FEV 1 ) occurred within 5 minutes. 1. Data on File, 272887, AZPLP. 2. Data on File, 273071, AZPLP. 3. Data on File, 273072, AZPLP.

31 Comments to AstraZeneca AstraZeneca is committed to conducting business with the highest standards of integrity and professionalism. If you have any comments that could improve the delivery of our promotional educational programs, please contact AstraZeneca at 1-800-236-9933 (C) 2009 AstraZeneca Pharmaceuticals LP. All rights reserved. 277388 3/09.


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