I have seen two changes since my last update. 1. Symbicort inhaler has a new actuator device. It has a built-in dose-counter. I have no experience with this device through clinical trials. Reportedly, every patient will receive this device automatically when they fill a Symbicort 160/4.5 script. AstraZeneca, the manufacturer, plans to begin marketing Symbicort 80/4.5 inhalers with a built-in counter in January of 2009. Built-in dose-counters are a good idea. Three other inhaled corticosteroids have one also: Advair, Asmanex, Pulmicort Flexhaler, not Qvar. 2. The F.D.A. approved Astepro on 10/10/08, which is a new formulation of Astelin, for the treatment of seasonal allergic rhinitis. Astepro Nasal Spray is supposed to be an improvement over the marketed Astelin Nasal Spray because it should be better tolerated by patients. The active substance in both of these products is azelastine. In phase 3 studies, fewer subjects reported bitter taste and nasal discomfort from Astepro user compared to Astelin. Symptom relief, as recorded by patients, was also better. In total, about 1,400 patients were involved in Meda's phase III studies. I have no direct experience with Astepro through clinical trials. No word on when the product will be marketed.