PHARMACEUTICAL COMPOSITIONS
FIELD OF INVENTION:
The present invention relates to pharmaceutical products and formulations comprising
R (+) budesonide. More particularly the present invention relates to pharmaceutical products
and formulations comprising R (+) budesonide, which products and formulations are useful
for the treatment and / or prevention of respiratory, inflammatory or obstructive airway
disease. The present invention also relates to a process for preparing the formulation
according to the present invention, therapeutic uses thereof and methods of treatment
employing the same.
BACKGROUND AND PRIOR ART:
Asthma and chronic obstructive pulmonary disease (COPD) are the most prevailing
conditions which affect most people. Airflow obstruction is the main characteristic feature in
each of these airway diseases and the medications utilized in the treatment are also often
similar.
The pathophysiology of asthma and related disorders involves various symptoms, including
bronchoconstriction, inflammation of the airways, and increased mucous secretion, which
results in wheezing, coughing and shortness of breath. A persistent or recurrent cough may
exacerbate the problem by causing further irritation and inflammation of the airways.
Bronchoconstriction occurs due to bronchial smooth muscle spasm and airway inflammation
with mucosal edema.
COPD is a severe respiratory condition that is increasing its prevalence worldwide. In India,
the estimated prevalence is about 12.36 million. It is currently the fourth leading cause of
death in the UK & US, and predicted to rank third in the global impact of disease by the year
2020.
COPD is a preventable and treatable disease state characterized by air flow limitation that is
not fully reversible. The airflow obstruction is usually progressive and associated with an
abnormal inflammatory response of the lungs to noxious particles or gases, primarily caused
by cigarette smoking. Although COPD affects the lungs it also produces significant systemic
consequences. COPD is associated with mucus hyper secretion, emphysema and
bronchiolitis.
Therapy for the treatment or prevention of COPD and asthma currently includes the use of
bronchodilators such as beta2-agonists, anticholinergics and steroids.
Inhaled bronchodilators are the foundation of pharmacotherapy for COPD because of their
capacity to alleviate symptoms, decrease exacerbations of disease and improve quality of life.
These drugs also improve airflow limitation and hyperinflation, thereby improving exercise
tolerance. In addition bronchodilators may reduce respiratory muscle fatigue (controversial)
and improve mucociliary clearance.
Long acting beta2-agonists improve lung function, reduce symptoms and protect against
exercise-induced dyspnea in patients with asthma and COPD. Long acting beta2-agonists
induce bronchodilation by causing prolonged relaxation of airway smooth muscle. In
addition to prolonged bronchodilation, long acting beta2-agonists (LABAs) exert other effects
such as inhibition of airway smooth-muscle cell proliferation and inflammatory mediator
release, as well as non smooth-muscle effects, such as stimulation of mucociliary transport,
cytoprotection of the respiratory mucosa and attenuation of neutrophil recruitment and
activation.
Long acting beta2-agonists reduce the symptoms that occur in the night or the early morning
which normally affect sleep patterns and reduce a patient's overall quality of life.
Further, use of a long acting beta2-agonist reduces the frequency of drug administration.
Anticholinergic agents are also a first choice for the symptomatic treatment of patients with
COPD.
Anticholinergic agents inhibit the muscarinic action of acetylcholine on structure innervated
by postganglionic cholinergic nerves. These agents typically inhibit bronchoconstriction by
relaxing the smooth muscles and causing considerable bronchodilation.
Even though it is also known that beta2-agonists and anticholinergics provide a symptomatic
relief in bronchoconstriction, another component of asthma, which is inflammation, requires
separate treatment such as with a steroid. Most of these inhaled corticosteroids need to be
administered in multiple dosage regimens.
Treatment with a corticosteroid / glucocorticoid is considered to be one of the most potent
and effective therapies currently available for persistent asthma. Corticosteroids exhibit
inhibitory effects on inflammatory cells and inflammatory mediators involved in the
pathogenesis of respiratory disorders.
Corticosteroids are used in several forms, to treat many different conditions. Because they
reduce itching, swelling, redness, and allergic reactions, they are often used in treating skin
problems, severe allergies, asthma, and arthritis.
Currently available corticosteroids include beclomethasone, budesonide, fluticasone,
mometasone and triamcinolone.
Combination therapy of a long-acting beta2-agonist, an anticholinergic and an inhaled
corticosteroid improves pulmonary efficiency, reduces inflammatory response and provides
symptomatic relief as compared to higher doses of inhaled corticosteroid alone in patients
affected by respiratory disorders such as asthma and COPD. However, the selection of a
specific long-acting beta2-agonist, a specific anticholinergic and a specific inhaled
corticosteroid plays a very important role in formulation of a fixed dose combination.
Combination therapy also simplifies treatment of respiratory disorders, reduces the cost of
treatment and provides control of the respiratory disorders. Reducing the dose frequency to
the minimum is a main step in simplifying COPD and asthma management for improving
patient adherence to the therapy.
US2009088408 discloses pharmaceutical compositions of anticholinergics, corticosteroids
and betamimetics and their use in the treatment of respiratory diseases.
US20050042174 discloses combined doses of asthma medicaments such as a combination of
doses of a beta2-agonist, an anticholinergic agent and an anti-inflammatory steroid.
WO2006 105401 discloses combination of an anticholinergic, a corticosteroid and a long
acting beta2-agonist for simultaneous and sequential administration in the prevention or
treatment of a respiratory, inflammatory or obstructive airway disease.
WO2004028545 discloses a combination of a long-acting beta2-agonist and a
glucocorticosteroid in the treatment of fibrotic diseases.
However, uses of corticosteroids, especially in children, have been limited due to potential
side effects. In children and teenagers, these medicines can stop or slow growth and affect the
function of the adrenal glands (small glands located above each kidney, which secrete natural
corticosteroids). Another possible problem for children is that corticosteroids may make
infections such as chickenpox and measles more serious.
The other side effects that are feared with corticosteroids include suppression of the
Hypothalarnic-Pituitary- Adrenal (HPA) axis, effects on bone growth in children and on bone
density in the elderly, ocular complications (cataract formation and glaucoma) and skin
atrophy. In older people, corticosteroids may increase the risk of high blood pressure and
bone disease. Bone problems from corticosteroids are especially likely in older women.
The benefits and risks of giving corticosteroids to children and teenagers should be
thoroughly discussed with a physician. By adjusting the doses and forms in which
corticosteroids are given, a physician may be able to lower the chance of unwanted side
effects.
Some corticosteroids exist as enantiomers and exhibit chirality. Enantiomers are structurally
identical compounds which differ only in that, one isomer is a mirror image of the other and
the mirror images cannot be superimposed. This phenomenon is known as chirality. Although
structurally identical, enantiomers can have profoundly different effects in biological
systems; one enantiomer may have a specific biological activity while the other enantiomer
may have no biological activity at all, or may have an entirely different form of biological
activity.
Budesonide, a corticosteroid, has been widely used in the treatment of chronic and asthmatic
bronchitis due to its strong anti-inflammatory action, high selectivity and fewer side effects.
The form ίwhich budesonide is presently used is a racemic mixture. That is, it is a mixture
of optical isomers, called enantiomers R (+) and S (-), which are characterized by different
strength and pharmacokinetic properties.
Budesonide, is chemically a mixture of two epimers 22R (+) and 22S (-) having a different
configuration at the acetal 22-carbon atom. R (+) budesonide, which consists mainly of
epimer 22R, is found to be clinically superior over the preparations consisting of a 1:1
mixture of the epimers.
The anti-inflammatory properties of R (+) isomer are nearly three times as strong as
compared to that of S (-) isomer. R (+) budesonide also shows greater volume of distribution
and plasma clearance. R (+) budesonide is very well tolerated and does not cause any serious
adverse effects. However as R (+) budesonide undergoes biotransformation more quickly
than S (-) isomer, the systemic action of R (+) budesonide is weaker as compared to that of
S (-) budesonide.
Budesonide is the mainstay in the treatment of respiratory and inflammatory or obstructive
airway diseases. However most of the formulations containing budesonide available in the
prior art contain the racemic mixture of budesonide.
Hence, there still remains a need to formulate pharmaceutical compositions comprising
R (+) budesonide for inhalation having reduced side effects, and to formulate pharmaceutical
compositions comprising R (+) budesonide in combination with one or more bronchodilators
for inhalation having reduced side effects.
OBJECT OF THE INVENTION:
The object of the present invention is to provide novel pharmaceutical compositions for
inhalation comprising R (+) budesonide and one or more bronchodilators for administration
in the prevention or treatment of respiratory, inflammatory or obstructive airway disease.
Another object of the present invention is to provide novel pharmaceutical compositions for
inhalation comprising R (+) budesonide and one or more bronchodilators for inhalation
having reduced side effects in the prevention or treatment of respiratory, inflammatory or
obstructive airway disease.
The compositions according to the invention may, of course, include one or more
pharmaceutically acceptable excipients.
Yet another object of the present invention is to provide a process for preparing novel
pharmaceutical compositions comprising R (+) budesonide and one or more bronchodilators
for administration in the prevention or treatment of respiratory, inflammatory or obstructive
airway disease.
A further object of the present invention is to provide pharmaceutical compositions
comprising R (+) budesonide and one or more bronchodilator for use in the prophylaxis or
treatment of respiratory, inflammatory or obstructive airway disease.
SUMMARY OF THE INVENTION:
According to a first aspect of the present invention, there is provided a pharmaceutical
composition comprising R (+) budesonide and one or more bronchodilators.
According to a second aspect of the present invention, there is provided a process for
preparing a pharmaceutical composition comprising R (+) budesonide and one or more
bronchodilators.
According to a third aspect of the present invention there is provided a pharmaceutical
composition comprising R (+) budesonide and one or more bronchodilators for use in treating
disorders or conditions that respond to, or are prevented, ameliorated or eliminated by, the
administration of R (+) budesonide, and one or more bronchodilators.
DETAILED DESCRIPTION OF THE INVENTION:
It has been found that the R (+) enantiomer of budesonide provides relief from bronchial
disorders, while simultaneously reducing undesirable side effects commonly experienced by
corticosteroid users. Further since the active enantiomer is used, the dose required is also
reduced as compared to that of racemic budesonide, which reduced dose also contributes to
the reduction in undesirable side effects.
The present invention thus provides novel pharmaceutical compositions for inhalation
comprising R (+) budesonide and one or more bronchodilators for administration in the
prevention or treatment of respiratory, inflammatory or obstructive airway disease while
simultaneously reducing undesirable side effects commonly experienced by corticosteroid
users.
According to the present invention, the optically pure R (+) isomer of budesonide may be
administered alone, or in combination with one or more bronchodilators or other drug(s) for
the treatment and / or prevention of respiratory, inflammatory or obstructive airway disease.
The other drugs may be selected from various classes of drugs commonly used for respiratory
diseases for example bronchodilators.
The present invention provides a pharmaceutical composition comprising R (+) budesonide
and one or more bronchodilators.
Bronchodilators used according to the present invention may be beta2-agonists and / or
anticholinergics. As discussed, the selection of a specific long-acting beta2-agonist, an
anticholinergic and inhaled corticosteroid plays a very important role in formulation of fixed
dose combination.
The terms "beta2-agonist agent" or "beta2-agonist" or "anticholinergic agent" or
"corticosteroids" are used in broad sense to include not only the beta2-agonist or
anticholinergic agent per se but also their pharmaceutically acceptable salts, pharmaceutically
acceptable solvates, pharmaceutically acceptable hydrates, pharmaceutically acceptable
enantiomers, pharmaceutically acceptable derivatives, pharmaceutically acceptable
enantiomers, pharmaceutically acceptable polymorphs, pharmaceutically acceptable
prodrugs, etc.
The present invention also provides a pharmaceutical composition comprising
R (+) budesonide and one or more beta2-agonists.
According to the present invention, beta2-agonists may comprise, one or more, short acting
beta2-agonists, long acting beta2-agonists or ultra long acting beta2-agonists.
The beta2-agonists that can be used, according to the present invention, include albuterol,
levoalbuterol, terbutaline, pirbuterol, procaterol, metaproterenol, fenoterol, bitolterol
mesylate, ritodrine, salmeterol, formoterol, arformoterol, carmoterol, bambuterol,
clenbuterol, indacaterol, milveterol, vilanterol, olodaterol.
According to one embodiment of the present invention the pharmaceutical composition may
comprise R (+) budesonide and formoterol with one or more pharmaceutically acceptable
excipients, R (+) budesonide and arformoterol with one or more pharmaceutically acceptable
excipients, R (+) budesonide and salmeterol with one or more pharmaceutically acceptable
excipients.
According to another embodiment of the present invention the pharmaceutical composition
may comprise R (+) budesonide, and carmoterol with one or more pharmaceutically
acceptable excipients.
According to yet another embodiment of the present invention the pharmaceutical
composition may comprise R (+) budesonide, and indacaterol with one or more
pharmaceutically acceptable excipients.
The present invention also provides a pharmaceutical composition comprising
R (+) budesonide and one or more anticholinergic agent.
Suitable anticholinergic agents include tiotropium, ipratropium and oxitropium.
According to one embodiment of the present invention the pharmaceutical composition may
comprise R (+) budesonide and tiotropium with one or more pharmaceutically acceptable
excipients, or R (+) budesonide and ipratropium with one or more pharmaceutically
acceptable excipients, or R (+) budesonide and oxitropium with one or more
pharmaceutically acceptable excipients.
The present invention also provides a pharmaceutical composition comprising
R (+) budesonide and one or more beta-agonist and one or more anticholinergic agents.
According to an embodiment of the present invention the pharmaceutical composition may
comprise R (+) budesonide, arformoterol and tiotropium with one or more pharmaceutically
acceptable excipients, or R (+) budesonide, arformoterol and tiotropium with one or more
pharmaceutically acceptable excipients or R (+) budesonide, tiotropium and carmoterol with
one or more pharmaceutically acceptable excipients, or R (+) budesonide, tiotropium and
indacaterol with one or more pharmaceutically acceptable excipients.
A preferred beta2-agonist for use in the present invention is carmoterol.
Carmoterol, chemically known as 8-hydroxy-5- (l-hydroxy-2- (N- (2- (4-methoxy phenyl) -
1-methyl ethyl) amino) ethyl) -2(1H) -quinolinone hydrochloride salt is a long acting beta2-
agonist characterized by having a rapid onset of action s, prolonged duration of action and
also having a high selectivity towards the beta2 adrenoreceptor. Furthermore carmoterol is
more potent than other long acting beta2-agonists.
Another preferred beta -agonist for use in the present invention is indacaterol.
Indacaterol is chemically known as (R)-5- [2- [(5,6-diethyl-2,3-dihydro-l H-inden-2-
yl)amino] - 1-hydroxy ethyl] -8-hydroxy quinolin-2(l H)-one is a ultra long acting beta2-
agonist. Furthermore indacaterol exhibits a longer duration of action as well as having a
greater cardiovascular safety margin.
A preferred anticholinergic agent for use in the present invention is tiotropium.
Tiotropium is chemically known as (la, 2, 4, 5a, 7) -7- [(hydroxy di-2-thienyl acetyl)
oxy] -9, 9-di methyl-3-oxa-9-azonia tricyclo [3.3. 1.02'4] nonane bromide monohydrate.
Tiotropium has duration of action of up to 32 hours. Also tiotropium causes an improvement
in dyspnea and a reduction in the need for rescue therapy.
Tiotropium in combination with pulmonary rehabilitation (PR) is associated with an
increased exercise endurance time and produces clinically meaningful improvements in
dyspnea and health status as compared to PR alone in COPD patients.
Further, tiotropium is more potent than ipratropium in the treatment of patients with COPD in
terms of the effect of lung function, dyspnea, exacerbation rates and health status.
The terms "carmoterol", "indacaterol" and "tiotropium" are used in broad sense to include
not only "carmoterol", "indacaterol" and "tiotropium" per se but also their pharmaceutically
acceptable salts, pharmaceutically acceptable solvates, pharmaceutically acceptable hydrates,
pharmaceutically acceptable esters, pharmaceutically acceptable enantiomers,
pharmaceutically acceptable derivatives, pharmaceutically acceptable polymorphs,
pharmaceutically acceptable prodrugs, etc.
The term " R (+) budesonide" is used in broad sense to include not only "R (+) budesonide"
per se but also its pharmaceutically acceptable salts, pharmaceutically acceptable solvates,
pharmaceutically acceptable hydrates, pharmaceutically acceptable esters, pharmaceutically
acceptable derivatives, pharmaceutically acceptable polymorphs, pharmaceutically
acceptable prodrugs, etc.
In accordance with the present invention, the preferred beta2-agonists are: carmoterol,
indacaterol, formoterol, arformoterol, salmeterol.
In accordance with the present invention, there preferred anticholinergics are: tiotropium,
oxitropium, ipratropium
Particularly preferred compositions according to the invention are pharmaceutical
compositions in which the beta2-agonist comprises or consists of carmoterol, indacaterol,
formoterol, aformoterol, salmeterol, and the anticholinergic comprise or consists of
tiotropium.
Particularly preferred compositions comprise:
R (+) budesonide, beta2-agonist comprising carmoterol, an anticholinergic comprising
tiotropium, and, optionally, one or more pharmaceutically acceptable excipients.
R (+) budesonide, beta2-agonist consisting of carmoterol, an anticholinergic
consisting of tiotropium, and, optionally, one or more pharmaceutically acceptable
excipients.
R (+) budesonide, beta -agonist comprising indacaterol, an anticholinergic comprising
tiotropium, and, optionally, one or more pharmaceutically acceptable excipients.
R (+) budesonide, beta2-agonist consisting of indacaterol, an anticholinergic
consisting of tiotropium, and, optionally, one or more pharmaceutically acceptable
excipients.
R (+) budesonide, beta -agonist comprising formoterol, and, optionally, one or more
pharmaceutically acceptable excipients.
R (+) budesonide, beta2-agonist consisting of formoterol, and, optionally, one or more
pharmaceutically acceptable excipients.
R (+) budesonide, beta -agonist comprising arformoterol, and, optionally, one or more
pharmaceutically acceptable excipients.
R (+) budesonide, beta -agonist consisting of arformoterol, and, optionally, one or
more pharmaceutically acceptable excipients.
According to the present invention, R (+) budesonide may be present in the composition in
the amount of about 80 meg to about 640 meg.
According to the present invention, carmoterol may be present in the composition in the
amount of about 1 meg to about 4 meg.
According to the present invention, indacaterol may be present in the composition in the
amount of about 50 meg to about 800 meg.
According to the present invention, tiotropium may be present in the composition in the
amount of about 9 meg to about 18 meg.
We have found that the combination therapy of R (+) budesonide, tiotropium and carmoterol
and the combination therapy of R (+) budesonide, tiotropium and indacaterol provide
effective methods for treating inflammatory and / or obstructive diseases of the respiratory
tract, particularly COPD or asthma.
Furthermore, the combination of R (+) budesonide, tiotropium and carmoterol and the
combination of R (+) budesonide, tiotropium and indacaterol provide a rapid onset of action
and improved control of obstructive or inflammatory airway diseases, or reduction in the
exacerbations of the diseases.
Another advantage of the combinations is that they facilitate the treatment of an obstructive
and inflammatory airway disease with a single medicament.
We have further found that the combination of R (+) budesonide, tiotropium and carmoterol,
and the combination of R (+) budesonide, tiotropium and indacaterol can each be
administered once a day in therapeutically effective amounts.
Further this combination therapy provides for administration of the combination by use of a
single inhaler for patients with severe COPD who currently have to make use of multiple
inhalers. This is particularly important since COPD is a disease of the elderly who may get
confused between the inhalers and who also suffer from several combined conditions such as
heart disease, arthritis etc. and are receiving other medications.
The pharmaceutical compositions of the present invention may be administered by any
suitable method used for delivery of drugs to the respiratory tract. The composition of the
present invention may thus be administered using metered dose inhalers (MDI), dry powder
inhalers (DPI), nebulisers, nasal sprays, nasal drops, insufflation powders, sprays and spray
patches.
Preferred embodiments of the invention comprise pharmaceutical compositions comprising
R (+) budesonide and one or more bronchodilators, which compositions are used in the form
of nebulisers, dry powder inhalers (DPI), nasal sprays, nasal drops, insufflation powders,
sprays and spray patches; in a particularly preferred embodiment, compositions are used in
the form of metered dose inhalers (MDI).
The various dosage forms according to the present invention may comprise carriers /
excipients suitable for formulating the same.
The metered dose inhalation formulations, according to the present invention may comprise
one or more pharmaceutically acceptable excipients, such as HFC / HFA propellants, cosolvents,
bulking agents, non volatile component, buffers / pH adjusting agents, surface
active agents, preservatives, complexing agents, lubricants, antioxidants or combinations
thereof.
In the context of the present invention, propellants are those substances which, when mixed
with the co-solvent(s), form a homogeneous propellant system in which a therapeutically
effective amount of a medicament can be dissolved. The HFC / HFA propellant must be
toxicologically safe and must have a vapor pressure which is suitable to enable the
medicament to be administered via a pressurized MDI.
According to the present invention the HFC / HFA propellants may comprise, one or more of
1,1,1,2-tetrafluoroethane (HFA-134(a)), 1,1,1,2,3,3,3,-heptafluoropropane (HFA-227), HFC-
32 (difluoromethane), HFC-143(a) (1,1,1-trifluoroethane), HFC-134 (1,1,2,2-
tetrafluoroethane), HFC-152a (1,1-difluoroethane) and such other propellants which may be
known to the person having a skill in the art.
In the context of the present invention, the co-solvent is any solvent which is miscible in a
formulation in the amount desired and which, when added, provides a formulation in which
the medicament can be dissolved. The function of the co-solvent is to increase the solubility
of the medicament and the excipients in the formulation.
According to the present invention the co-solvent may comprise one or more of C2-C6
aliphatic alcohols, such as but not limited to ethyl alcohol and isopropyl alcohol; glycols such
as but not limited to propylene glycol, polyethylene glycols, polypropylene glycols, glycol
ethers, and block copolymers of oxyethylene and oxypropylene; and other substances, such
as but not limited to glycerol, polyoxyethylene alcohols, and polyoxyethylene fatty acid
esters; hydrocarbons such as but not limited to n-propane, n-butane, isobutane, n-pentane,
iso-pentane, neo-pentane, and n-hexane; and ethers such as but not limited to diethyl ether.
Suitable surfactants may be employed in the aerosol solution formulation of the present
invention, which surfactants may serve to stabilize the solution formulation and improve the
performance of valve systems within a metered dose inhaler.
According to the present invention the surfactant may comprise one or more ionic and / or
non-ionic surfactant, but not limited to oleic acid, sorbitan trioleate, lecithin,
isopropylmyristate, tyloxapol, polyvinylpyrrolidone polysorbates such as polysorbate 80,
vitamin E-TPGS, and macrogol hydroxystearates such as macrogol-15-hydroxystearate.
In the context of the present invention, the non-volatile component is all the suspended or
dissolved constituents that would be left after evaporation of the solvent.
According to the present invention, the non-volatile component may comprise one or more of
monosaccharides such as but not limited to glucose, arabinose; disaccharides such as lactose,
maltose; oligosaccharides and polysaccharides such as but not limited to dextrans;
polyalcohol such as but not limited to glycerol, sorbitol, mannitol, xylitol; salts such as but
not limited to potassium chloride, magnesium chloride, magnesium sulphate, sodium
chloride, sodium citrate, sodium phosphate, sodium hydrogen phosphate, sodium hydrogen
carbonate, potassium citrate, potassium phosphate, potassium hydrogen phosphate, potassium
hydrogen carbonate, calcium carbonate and calcium chloride.
Suitable bulking agents may be employed in the metered dose inhalation formulations of the
present invention.
According to the present invention, the bulking agent may comprise one or more saccharides,
including monosaccharides, disaccharides, polysaccharides and sugar alcohols such as
arabinose, glucose, fructose, ribose, mannose, sucrose, terhalose, lactose, maltose, starches,
dextran or mannitol.
Suitable buffers or pH adjusting agents may be employed in the metered dose inhalation
formulations of the present invention.
According to the present invention, the buffer or the pH adjusting agent may comprise one or
more of organic or inorganic acids such as but not limited to citric acid, ascorbic acid,
hydrochloric acid, sulfuric acid, nitric acid, or phosphoric acid.
Suitable preservatives may be employed in aerosol solution formulations of the present
invention to protect such formulations from contamination with pathogenic bacteria.
According to the present invention, the preservative may comprise one or more of
benzalkonium chloride, benzoic acid, benzoates such as sodium benzoate and such other
preservatives which may be known to the person having a skill in the art.
Suitable complexing agents may be employed in aerosol solution formulations of the present
invention, which complexing agents are capable of forming complex bonds.
According to the present invention, the complexing agent may comprise one or more of but
not limited to sodium EDTA or disodium EDTA.
A further preferred embodiment of the present invention can be where the composition is in
the form of insufflatable powder. R (+) budesonide in combination with one or more
bronchodilator may be mixed with inert carrier substances or drawn up onto inert carrier
substances to form insufflatable powders.
A dry powder insufflation composition according to the present invention can be
administered by the use of an insufflator, which can produce a finely divided cloud of the dry
powder. The insufflator preferably is provided with means to ensure administration of a
substantially pre-determined amount of a formulation or product as provided by the present
invention. The powder may be used directly with an insufflator, which is provided with a
bottle or container for the powder, or the powder may be filled into a capsule or cartridge,
such as a gelatin capsule, or other single dose device adapted for administration. The
insufflator preferably has means to open the capsule or other dose device.
A further preferred embodiment of the present invention can be where the composition is in
the form of dry powder inhaler (DPI). R (+) budesonide in combination with one or more
bronchodilator may be mixed with inert carrier substances or drawn up onto inert carrier
substances to form dry powder inhalation formulations.
Carrier substances suitable for forming the insufflation powders or dry powder inhalation
formulations of the present invention include but are not limited to sugars/sugar alcohols
such as glucose, saccharose, lactose and fructose, starches or starch derivatives,
oligosaccharides such as dextrins, cyclodextrins and their derivatives, polyvinylpyrrolidone,
alginic acid, tylose, silicic acid, cellulose, cellulose derivatives (for example cellulose ether),
sugar alcohols such as mannitol or sorbitol, calcium carbonate, calcium phosphate, lactose,
lactitol, dextrates, dextrose, maltodextrin, saccharides including monosaccharides,
disaccharides, polysaccharides; sugar alcohols such as arabinose, ribose, mannose, sucrose,
trehalose, maltose and dextran.
In another embodiment of the present invention the composition may be in the form of a
nebuliser formulation.
Nebulisation therapy has an advantage over other inhalation therapy, since it is easy to use
and does not require co-ordination or much effort. It also works much more rapidly than
medicines taken by mouth.
For nebulisers, the composition according to the present invention may comprise suitable
excipients such as osmotic agents, pH regulators buffering agent, wetting agent and
complexing agents in a suitable vehicle.
Osmotic agents, which may be used in nebuliser formulations according to the present
invention include sodium chloride, potassium chloride, zinc chloride, calcium chloride and
mixtures thereof. Other suitable osmotic agents include, but are not limited to, mannitol,
glycerol, dextrose and mixtures thereof.
The pH of a nebuliser formulation may be adjusted by the addition of pharmacologically
acceptable acids. Pharmacologically acceptable inorganic acids or organic acids may be used
for this purpose. Examples of preferred inorganic acids are selected from the group consisting
of hydrochloric acid, hydrobromic acid, nitric acid, sulphuric acid and phosphoric acid and
mixtures thereof. Examples of particularly suitable organic acids are selected from the group
consisting of ascorbic acid, citric acid, malic acid, tartaric acid, maleic acid, succinic acid,
fumaric acid, acetic acid, formic acid and propionic acid and mixtures thereof.
Complexing agents that may be used in nebuliser formulations according to the present
invention include editic acid (EDTA) or one of the known salts thereof, e.g. sodium EDTA or
disodium EDTA dihydrate (sodium edetate).
Wetting agents that may be used in nebuliser formulations according to the present invention
include sodiumdioctylsulfosuccinate; polysorbates such as polysorbate 20, polysorbate 40,
polysorbate 60, polysorbate 80, polysorbate 65, polysorbate 85; sorbitan fatty acid esters such
as Span 20, Span 40, Span 60 Span 80, Span 120; sodium lauryl sulfate; polyethoxylated
castor oil; polyethoxylated hydrogenated castor oil and mixtures thereof.
Anti-microbial preservative agent may also be added for multi-dose packages.
The formulation according to the present invention may be included in suitable containers
provided with means enabling the application of the contained formulation to the respiratory
tract.
The dry powder inhalation formulations of the present invention may either be encapsulated
in capsules of gelatin or HPMC, or in blisters. Alternatively, the dry powder inhalation
formulations may be contained in a reservoir either in a single dose or multi-dose dry powder
inhalation device.
Alternatively, the dry powder inhalation formulations may be suspended in a suitable liquid
vehicle and packed in an aerosol container along with suitable propellants or mixtures
thereof.
Further, the dry powder inhalation formulations may also be dispersed in a suitable gas
stream to form an aerosol composition.
The metered dose inhalation formulations of the present invention may be packed in plain
aluminium cans or in SS (stainless steel) cans. Some aerosol drugs tend to adhere to the inner
surfaces, i.e. walls, of the cans and valves. This can lead to the patient getting significantly
less than the prescribed amount of the active agent upon each activation of a metered dose
inhaler. Coating the inner surface of the container with a suitable polymer can reduce this
adhesion problem. Suitable coatings include fluorocarbon copolymers such as FEP-PES
(fluorinated ethylene propylene and poly ether sulphone) and PFA-PES (perfluoro alkoxy
alkane and poly ether sulphone), epoxy and ethylene. Alternatively, the inner surfaces of the
cans may be anodized, plasma treated or plasma coated.
It will be understood by a person skilled in the art that the pharmaceutical composition,
according to the present invention, may further comprise (i.e. in addition to the
bronchodilator, i.e., the beta2-agonist and/or the anticholinergic) one or more active(s)
selected from antihistamines, antiallergics or leukotriene antagonist or their pharmaceutically
acceptable salts, solvates, tautomers, derivatives, enantiomers, isomers, hydrates, prodrugs or
polymorphs thereof.
The present invention also provides a process to manufacture the compositions according to
the present invention.
Thus the present invention provides a process of preparing a metered dose inhalation
formulation which process comprises admixing more or more pharmaceutically acceptable
carriers and/or excipients with the actives (e.g. R (+) budesonide and one or more
bronchodilators) and the propellant, and optionally providing the formulation in precrimped
cans.
The present invention also provides a process of preparing a dry powder inhalation
formulation which process comprises admixing of one or more pharmaceutically acceptable
carriers and/or excipients with the actives (e.g. R (+) budesonide and one or more
bronchodilator) and providing the formulation as a dry powder inhaler.
The present invention also provides a process of preparing an inhalation solution which
process comprises dissolving the drugs, optionally chelating agents, osmotic agents and any
other suitable ingredients in the vehicle and adjusting the pH using a suitable pH adjusting
agent.
The present invention further provides a method for the treatment in a mammal, such as a
human, for treating respiratory, inflammatory or obstructive airway disease such as COPD
and asthma, which method comprises administration of a therapeutically effective amount of
a pharmaceutical composition according to the present invention. The method of treatment
may be characterized in that R (+) budesonide and one or more bronchodilators are
administered once a day in therapeutically effective amounts, e.g. R (+) budesonide,
tiotropium and carmoterol or R (+) budesonide, tiotropium and indacaterol are administered
once a day in therapeutically effective amounts.
Furthermore, the present invention provides pharmaceutical compositions comprising
R (+) budesonide and one or more bronchodilators for use in the prophylaxis or treatment of
respiratory, inflammatory or obstructive airway disease.
The following examples are for the purpose of illustration of the invention only and are not
intended in any way to limit the scope of the present invention.
Example 1
Sr. No. Ingredients Qty / Can
1. R (+) Budesonide 16 g
2. Arformoterol tartarate 0.48 mg
3. HFA134a 9.6 g
Process:
(1) R (+) Budesonide and Arformoterol tartarate were dispersed with the propellant.
(2) The suspension obtained in step (1) was filled in precrimped cans.
Example 2
Sr. No. Ingredients Qty / Can
1. R (+) Budesonide 16 mg
2. Arformoterol tartarate 0.48 mg
3. 2% Ethanol 0.22 g
4. 0.22% Lecithin 0.0003 mg
5. HFA227 l l.O g
Process:
(1) Lecithin was dispersed in ethanol.
(2) R (+) Budesonide and Arformoterol tartarate were dispersed in the mixture as obtained in
step (1).
(3) The drug suspension was mixed with propellant HFA277.
(4) The suspension obtained in step (3) was filled in precrimped cans.
£xamp|e 3
Process:
(1) R (+) Budesonide and Arformoterol tartarate were dispersed with the propellant.
(2) The suspension obtained in step (1) was filled in precrimped cans.
Example 4
Process:
(1) PVP was dispersed in PEG.
(2) R (+) Budesonide and Arformoterol tartarate were dispersed in the mixture as obtained in
step (1).
(3) The drug suspension was mixed with propellant HFA277.
(4) The suspension obtained in step (3) was filled in precrimped cans.
Example 5
Process:
(1) R (+) Budesonide and Formoterol fumarate were dispersed with the propellant.
(2) The suspension obtained in step (1) was filled in precrimped cans.
Example 6
Process:
(1) Lecithin was dispersed in ethanol.
(2) R (+) Budesonide and Formoterol fumarate were dispersed in the mixture as obtained in
step (l).
(3) The drug suspension was mixed with propellant HFA277
(4) The suspension obtained in step (3) was filled in precrimped cans.
Example 7
Process:
(1) R (+) Budesonide and Formoterol fumarate were dispersed with the propellant.
(2) The suspension obtained in step (1) was filled in precnmped cans.
Example 8
Process:
(1) PVP was dispersed in PEG.
(2) R (+) Budesonide and Formoterol fumarate were dispersed in the mixture as obtained in
step (1).
(3) The drug suspension was mixed with propellant HFA277.
(4) The suspension obtained in step (3) was filled in precnmped cans.
Example 9
Process:
(1) R (+) Budesonide, Tiotropium and Carmoterol were homogenized with a part quantity of
HFA.
(2) The suspension obtained in step (1) was transferred to the mixing vessel where the
remaining quantity of HFA was added.
(3) The resulting suspension was mixed, recirculated and filled into pre-crimped aluminum
cans.
Example 10
Process:
(1) R (+) Budesonide, Tiotropium and Carmoterol were homogenized with lactose and a part
quantity of HFA.
(2) The suspension obtained in step (1) was transferred to the mixing vessel where the
remaining quantity of HFA was added.
(3) The resulting suspension was mixed, recirculated and filled in into pre-crimped aluminum
cans.
Example 11
Process:
(1) PVP was dissolved in PEG and part quantity of HFA.
(2) The solution obtained in step (1) was transferred to a mixing vessel.
(3) R (+) Budesonide, Tiotropium and Carmoterol were homogenized with a part quantity of
HFA.
(4) The suspension obtained in step (3) was transferred to the mixing vessel where remaining
quantity of HFA was added.
(5) The resulting total suspension was mixed, recirculated and filled in into pre-crimped
aluminum cans.
Example 12
Sr. No. Ingredients Qty / Spray
1. R (+) Budesonide 100 meg
2. Tiotropium 9 meg
3. Carmoterol 1 meg
4. Ethanol 15-20% of total
formulation
5. Glycerol 1% of total
formulation
6. HCL (0.08N) pH 2.5 - 3.5
HFA134a q.s.
Process:
(1) Glycerol was dissolved in ethanol and required quantity of HC1 was added.
(2) R (+) Budesonide, Tiotropium and Carmoterol were dissolved in the solution obtained in
step (l).
(3) The resulting solution was transferred to the mixing vessel where HFA was added.
(4) The resulting solution was mixed, recirculated and filled in into pre-crimped aluminum
cans.
Example 13
Process:
(1) Required quantity of HC1 was added to ethanol.
(2) R (+) Budesonide, Tiotropium and Carmoterol were dissolved in the solution obtained in
step (1).
(3) The resulting solution was transferred to the mixing vessel where HFA was added.
(4) The resulting solution was mixed, recirculated and filled in into pre-crimped aluminum
cans.
Example
Sr. No. Ingredients Qty / Spray
I . R (+) Budesonide 00 meg
2. Tiotropium 9 meg
3. Carmoterol 1 meg
4. Ethanol 15-20% of total
formulation
5. Glycerol 1% of total
formulation
6. Citric acid anhydrous pH 2.5 - 3.5
7. HFA134a q.s.
Process:
(1) Required quantity of citric acid and glycerol was added to ethanol.
(2) R (+) Budesonide, Tiotropium and Carmoterol were dissolved in the solution obtained in
step (l).
(3) The resulting solution was transferred to the mixing vessel where HFA was added.
(4) The resulting solution was mixed, recirculated and filled in into pre-crimped aluminum
cans.
Example 15
Process:
(1) Required quantity of citric acid was added to ethanol.
(2) R (+) Budesonide, Tiotropium and Carmoterol were dissolved in the solution obtained in
step (1).
(3) The resulting solution was transferred to the mixing vessel where HFA was added.
(4) The resulting solution was mixed, recirculated and filled in into pre-crimped aluminum
cans.
Example 16
Process:
(1) Required quantity of lecithin was added to ethanol.
(2) Tiotropium and Carmoterol were homogenized with part quantity of HFA and transferred
to the mixing vessel.
(3) R (+) Budesonide was homogenized with the solution obtained from step (1) and part
quantity of HFA.
(4) The suspension obtained in step (4) was transferred to the mixing vessel where the
remaining quantity of HFA was added.
(5) The resulting suspension is then mixed, recirculated and filled in into pre-crimped
aluminum cans.
Example 17
Process:
(1) Required quantity of oleic acid was added to ethanol.
(2) Tiotropium and Carmoterol were homogenized with part quantity of HFA and transferred
to the mixing vessel.
(3) R (+) Budesonide was homogenized with the solution obtained from step (1) and part
quantity of HFA.
(4) The suspension obtained in step (4) was transferred to the mixing vessel where remaining
quantity of HFA was added.
(5) The resulting suspension is then mixed, recirculated and filled in into pre-crimped
aluminum cans.
Example 18
Process:
(1) R (+) Budesonide, Caromoterol, Tiotropium Bromide Monohydrate were sifted with a
part quantity of lactose.
(2) The cosift of step (1) was then sifted with the remaining quantity of lactose and blended.
(3) The blend of step (2) was then filled in capsules.
Example 19
Process:
(1) R (+) Budesonide, Caromoterol, Tiotropium Bromide Monohydrate were sifted with a
part quantity of lactose.
(2) The cosift of step (1) was then sifted with the remaining quantity of lactose and blended.
(3) The blend of step (2) was then filled in capsules.
Example 20
Process:
(1) R (+) Budesonide, Tiotropium and Indacaterol were homogenized with a part quantity of
HFA.
(2) The suspension obtained in step 1 was transferred to the mixing vessel where the
remaining quantity of HFA was added.
(3) The resulting suspension was mixed, recirculated and filled in into pre-crimped aluminum
cans.
Example 21
Process:
(1) R (+) Budesonide, Tiotropium and Indacaterol were homogenized with lactose and a part
quantity of HFA.
(2) The suspension obtained in step 1 was transferred to the mixing vessel where the
remaining quantity of HFA was added.
(3) The resulting suspension was mixed, recirculated and filled in into pre-crimped aluminum
cans.
Example 22
Process:
(1) PVP was dissolved in PEG and part quantity of HFA.
(2) The solution obtained in Step 1 was transferred to a mixing vessel.
(3) R (+) Budesonide, Tiotropium and Indacaterol were homogenized with a part quantity of
HFA.
(4) The suspension obtained in step 3 was transferred to the mixing vessel where remaining
quantity of HFA was added.
(5) The resulting total suspension was mixed, recirculated and filled in into pre-crimped
aluminum cans.
Example 23
Process:
(1) Glycerol was dissolved in ethanol and required quantity of HC1 was added.
(2) R (+) Budesonide, Tiotropium and Indacaterol were dissolved in the solution obtained in
step (l).
(3) The resulting solution was transferred to the mixing vessel where HFA was added.
(4) The resulting solution was mixed, recirculated and filled in into pre-crimped aluminum
cans.
Example 24
Sr. No. Ingredients Qty / Spray
1. R (+) Budesonide 100 meg
2. Tiotropium 9 meg
3. Indacaterol 50 meg
4. Ethanol 15-20% of total
formulation
5. HCL ( 0.08N) pH 2.5-3.5
6. HFA134a q.s.
Process:
(1) Required quantity of HC1 was added to ethanol.
(2) R (+) Budesonide, Tiotropium and Indacaterol were dissolved in the solution obtained in
step (l).
(3) The resulting solution was transferred to the mixing vessel where HFA was added.
(4) The resulting solution was mixed, recirculated and filled in into pre-crimped aluminum
cans.
Example 25
Process:
(1) Required quantity of citric acid and glycerol was added to ethanol.
(2) R (+) Budesonide, Tiotropium and Indacaterol were dissolved in the solution obtained in
step (l).
(3) The resulting solution was transferred to the mixing vessel where HFA was added.
(4) The resulting solution was mixed, recirculated and filled in into pre-crimped aluminum
cans.
Example 26
Process:
1) Required quantity of citric acid was added to ethanol.
2) R (+) Budesonide, Tiotropium and Indacaterol were dissolved in the solution obtained in
step (1).
3) The resulting solution was transferred to the mixing vessel where HFA was added.
4) The resulting solution was mixed, recirculated and filled in into pre-crimped aluminum
cans.
Example 27
Sr. No. Ingredients Qty / Spray
1. R (+) Budesonide 100 meg
2. Tiotropium 9 meg
3. Indacaterol 50 meg
4. Ethanol 1-2% of total
formulation
5. Lecithin 0.02 of the API
6. HFA134a or HFA227 q.s.
Process:
1) Required quantity of lecithin was added to ethanol.
2) Tiotropium and Indacaterol were homogenized with part quantity of HFA and transferred
to the mixing vessel.
3) R (+) Budesonide was homogenized with the solution obtained from step (1) and part
quantity of HFA.
4) The suspension obtained in step (4) was transferred to the mixing vessel where remaining
quantity of HFA was added.
5) The resulting suspension is then mixed, recirculated and filled in into pre-crimped
aluminum cans.
Example 28
Process:
1) Required quantity of oleic acid was added to ethanol.
2) Tiotropium and Indacaterol were homogenized with part quantity of HFA and transferred
to the mixing vessel.
3) R (+) Budesonide was homogenized with the solution obtained from step (1) and part
quantity of HFA.
4) The suspension obtained in step (4) was transferred to the mixing vessel where the
remaining quantity of HFA was added.
5) The resulting suspension is then mixed, recirculated and filled in into pre-crimped
aluminum cans.
Example 29
Process:
(1) R (+) Budesonide, Indacaterol maleate, Tiotropium Bromide Monohydrate were sifted
with a part quantity of lactose.
(2) The cosift of step (1) was then sifted with the remaining quantity of lactose and blended.
(3) The blend of step (2) was then filled in capsules.
Example 30
Process:
(1) R (+) Budesonide, Indacaterol maleate, Tiotropium Bromide Monohydrate were sifted
with a part quantity of lactose.
(2) The cosift of step 1 was then sifted with the remaining quantity of lactose and blended.
(3) The blend of step 2 was then filled in capsules.
It will be readily apparent to one skilled in the art that varying substitutions and
modifications may be made to the invention disclosed herein without departing from the
spirit of the invention. Thus, it should be understood that although the present invention has
been specifically disclosed by the preferred embodiments and optional features, modification
and variation of the concepts herein disclosed may be resorted to by those skilled in the art,
and such modifications and variations are considered to fall within the scope of the invention.
It is to be understood that the phraseology and terminology used herein is for the purpose of
description and should not be regarded as limiting. The use of "including," "comprising," or
"having" and variations thereof herein is meant to encompass the items listed thereafter and
equivalents thereof as well as additional items.
It must be noted that, as used in this specification and the appended claims, the singular
forms "a," "an" and "the" include plural references unless the context clearly dictates
otherwise. Thus, for example, reference to "an excipient" includes a single excipient as well
as two or more different excipients, and the like.
CLAIMS:
1. A pharmaceutical composition comprising R (+) budesonide and one or more
bronchodilators, and, optionally, one or more pharmaceutically acceptable excipients.
2. A pharmaceutical composition according to claim 1, wherein R (+) budesonide in an
amount ranging from 80-640mcg.
3. A pharmaceutical composition according to claim 1 or 2, wherein the bronchodilator
comprises one or more beta -agonists.
4. A pharmaceutical composition according to claim 3, wherein the beta2-agonist is
selected from albuterol, levoalbuterol, terbutaline, pirbuterol, procaterol, metaproterenol,
fenoterol, bitolterol mesylate, ritodnne, salmeterol, formoterol, arformoterol, carmoterol,
bambuterol, clenbuterol, indacaterol, milveterol, vilanterol, olodaterol or a combination
thereof.
5. A pharmaceutical composition according to claim 3 or 4, wherein the beta2-agonist
comprises formoterol.
6. A pharmaceutical composition according to claim 3 or 4, wherein the beta -agonist
comprises arformoterol
7. A pharmaceutical composition according to claim 3 or 4, wherein the beta -agonist
comprises salmeterol.
8. A pharmaceutical composition according to claim 3 or 4 wherein the beta2-agonist
comprises carmoterol.
9. A pharmaceutical composition according to claim 3, 4 or 8 wherein carmoterol is in
an amount ranging from lmcg - 4mcg.
10. A pharmaceutical composition according to claim 3 or 4, wherein the beta2-agonist
comprises indacaterol.
1. A pharmaceutical composition according to claim 3, 4, or 10 wherein indacaterol is in
5 an amount ranging from 50mcg - 800mcg.
12. A pharmaceutical composition according to any one of the preceding claims, wherein
the bronchodilator comprises one or more anticholinergics.
10 13. A pharmaceutical composition according to claim 12, wherein the anticholinergic is
selected from tiotropium, ipratropium, oxitropium and combinations thereof.
14. A pharmaceutical composition according to claim 12 or 13, wherein the
anticholinergic comprises tiotropium.
15
15. A pharmaceutical composition according to claim 12, 3 or 14 wherein tiotropium is
in an amount ranging from 9mcg - 18mcg.
16. A pharmaceutical composition according to claim 12, 13, 14 or 15, wherein the
20 anticholinergic comprises oxitropium.
17. A pharmaceutical composition according to claim 12 13, 14, or 15, wherein the
anticholinergic comprises ipratropium.
25 18. A pharmaceutical composition according to claim 1, wherein the bronchodilator
comprises one or more beta2-agonists and/or one or more anticholinergics.
19. A pharmaceutical composition according to claim 1 or 18, comprising
R (+) budesonide and formoterol .
30
20. A pharmaceutical composition according to claim 1 or 18, comprising R (+) budesonide
and arformoterol
21. A pharmaceutical composition according to claim 1 or 18, comprising
R (+) budesonide, tiotropium and carmoterol.
5 22. A pharmaceutical composition according to claim 1 or 18, comprising
R (+) budesonide, tiotropium and indacaterol.
23. A pharmaceutical composition according to any one of the preceding claims wherein
R (+) budesonide and beta2-agonists along with any excipients are formulated in a single
10 pharmaceutical composition.
24. A pharmaceutical composition according to any one of the preceding claims wherein
R (+) budesonide and anticholinergics along with any excipients are formulated in a single
pharmaceutical composition.
15
25. A pharmaceutical composition according to any one of the preceding claims wherein
beta2-agonists and anticholinergics along with any excipients are formulated in a single
pharmaceutical composition.
20 26. A pharmaceutical composition according to any one of the preceding claims wherein
R (+) budesonide, beta -agonists and anticholinergics along with any excipients are
formulated in a single pharmaceutical composition.
27. A pharmaceutical composition according to any one of the preceding claims,
25 formulated as an inhalation composition.
28. A pharmaceutical composition according to any one of claims 1 to 26, formulated for
use in a metered dose inhaler.
30 29. A pharmaceutical composition according to claim 27 or 28, further comprising a
propellant.
30. A pharmaceutical composition according to claim 27, 28 or 29, further comprising an
excipient selected from a cosolvent, an antioxidant, a surfactant, a bulking agent and a
lubricant.
5 31. A pharmaceutical composition according to any one of claims 1 to 26, formulated for
use as a dry powder inhalation formulation.
32. A pharmaceutical composition according to claim 31, further comprising at least one
finely divided pharmaceutically acceptable carrier suitable for use in dry powder inhalation
10 formulations.
33. A combination composition according to claim 32, wherein said carrier includes a
saccharide and/or a sugar alcohol.
15 34. A combination composition according to any one of claims 1 to 26, formulated for
use as an inhalation solution.
35. A combination composition according to claim 34, further comprising an
excipient selected from a wetting agent, osmotic agent, a pH regulator, a buffering agent and
a complexing agent, provided in a pharmaceutically acceptable vehicle.
36. A pharmaceutical composition according to any one of the claims 1 to 26 formulated
for inhalation, for use as a nasal spray, for use as nasal drops, for use as an insufflation
powder, or for use as a spray patch.
37. A pharmaceutical composition according to any one of the preceding claims for once
daily administration.
38. A pharmaceutical composition according to any one of the preceding claims further
comprising one or more active(s) selected from antihistamines, antiallergics or leukotriene
antagonist or their pharmaceutically acceptable salts, solvates, tautomers, derivatives,
enantiomers, isomers, hydrates, prodrugs or polymorphs thereof.
39. A process for manufacturing a pharmaceutical composition according to any one of
5 claims 1 to 26 comprising combining R (+) budesonide with one or more bronchodilators and
one or more optional pharmaceutically acceptable excipients.
40. The use of R (+) budesonide and a bronchodilator in the manufacture of a
medicament for the prophylaxis or treatment of a respiratory, inflammatory or obstructive
10 airway disease.
4 . The use according to claim 40, wherein the bronchodilator is as defined in any one of
claims 3 to 18.
5 42. The use according to claim 40 or 41, wherein said medicament is for once daily
administration.
43. The use according to claim 40, 1 or 42, wherein the disease is COPD or asthma.
20 44. A method of prophylaxis or treatment of a respiratory, inflammatory or obstructive
airway disease, comprising administering a therapeutically effective amount of a
pharmaceutical composition according to any one of claims 1 to 26 to a patient in need
thereof.
25 45. A method according to claim 44, wherein said pharmaceutical composition is
administered once daily.
46. A method according to claim 44 or 45, wherein the disease is COPD or asthma.
30 47. A pharmaceutical composition substantially as herein described with reference to the
examples.
48. A process for making a pharmaceutical composition substantially as herein described
with reference to the examples.