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Fact Checked

A New Combination Inhaler Approved for Treatment of COPD: Breztri Aerosphere

Chronic Obstructive Pulmonary Disease (COPD) is the fourth leading cause of death in the United States. More than 15 million Americans are affected by COPD, and it’s estimated that more than 140,000 die from COPD related causes each year. 

Living with COPD can be very difficult, and it’s commonly treated with different inhaler medications. The FDA recently approved a new combination inhaler called Breztri AerosphereTM for the treatment of COPD. Let’s explore what science says about the benefits of this new medication! 

What is COPD?

COPD is a disease that causes inflammation that can block the normal airways in your lungs and make it harder to breathe. COPD disease gets worse over time, and there is currently no cure. Since COPD cannot be reversed, the main treatment is to use medications to manage symptoms and slow down the disease. 

For some patients, managing symptoms of COPD can be quite complicated and can often lead to an exacerbation. A “COPD exacerbation” is just a fancy way of saying a sudden worsening of symptoms. 

Common symptoms of COPD include:

  • Persistent cough 
  • mucus production from the lungs
  • shortness of breath 
  • Feeling of tightness in your chest

Common risk factors for developing COPD include:

  • Cigarette smoking (CDC reports 8 out of 10 COPD deaths are related to smoking)
  • Occupational exposures (e.g., pesticides, gases, fumes) 
  • Asthma
  • History of severe lung infections 

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What is Breztri AerosphereTM?

Breztri AerosphereTM is a combination inhaler that includes three medications: budesonide, glycopyrrolate, and formoterol fumarate. These three medications each work in a different way to provide relief of COPD symptoms. 

Budesonide is an inhaled corticosteroid (ICS) that works by reducing inflammation in the airways, making it easier to breathe

Glycopyrrolate is a long-acting muscarinic antagonist (LAMA) that works by blocking a neurotransmitter called acetylcholine, which relaxes the muscles in the airways to allow for more air to get to the lungs. 

Formoterol fumarate is a long-acting beta-2 agonist (LABA) that works by stimulating receptors in the airways called beta-2 receptors. When these receptors are activated, they also relax the muscles in the airways to make it easier to breathe. 

What Does the Research Show?

Two studies were conducted that looked at the use of Breztri AerosphereTM for COPD management.  

The ETHOS trial looked at patients who had a history of COPD exacerbations and compared the Breztri AerosphereTM inhaler with two different inhalers that are commonly used for COPD treatment. This study found that Breztri AerosphereTM had a significantly lower rate of COPD exacerbations. 

The KRONOS trial looked at patients who had symptoms of COPD and compared overall lung function between Breztri AerosphereTM and other common inhalers used in COPD. The results showed that patients who used Breztri AerosphereTM had better lung function after 24 weeks. 

Both studies showed that Breztri AerosphereTM may be used as another option for medication management of COPD.

How Do I Use Breztri AerosphereTM?

Breztri AerosphereTM is a metered-dose inhaler that is taken twice a day. To make sure you are getting the most benefits from your inhaler, you must understand how to use it correctly:

  1. Remove the cap and shake the inhaler
  2. Exhale deeply away from the mouthpiece of your inhaler to empty your lungs
  3. Place the mouthpiece gently between your lips and breath in slowly and deeply while also pressing down on the inhaler
  4. Remove the inhaler and hold your breath for about 10 seconds
  5. Breath out slowly
  6. Rinse your mouth out with water (do NOT swallow) 
  7. Close the cap on the inhaler and store in a cool, dry place until its next use

What are the Side Effects?

Some common side effects to look out for while taking Breztri AerosphereTM are:

Back pain

Cough

Headache

Diarrhea

Nausea

Inflammation of the sinuses

Muscle spasms

Difficulty sleeping

Upper respiratory tract infection

Pneumonia (infection of the lungs)

Feeling anxious

Increased heart rate

Make sure to talk to your doctor or pharmacist if any of these side effects become too severe or affect your daily life. 

The Takeaway

COPD is one of the leading causes of death in the United States. Breztri AerosphereTM is a recently approved inhaler that combines three different medications to help treat COPD. The research showed that Breztri AerosphereTM led to fewer COPD exacerbations and improved lung function when compared to other commonly used inhalers. Make sure to talk to your doctor or pharmacist about the best way to manage your COPD medications. 

Reference List

  1. Kochanek KD, Murphy SL, Xu J, Arias E. Mortality in the United States, 2016. NCHS Data Brief 2017; 293. https://www.cdc.gov/nchs/data/databriefs/db293.pdf. Published 2017. Accessed 1 September 2020. 
  2. Centers for Disease Control and Prevention. Disease or Condition of the Week: COPD. https://www.cdc.gov/dotw/copd/index.html. Last Reviewed 2019. Accessed 1 September 2020. 
  3. U.S. Food and Drug Administration. [email protected]: FDA-Approved Drugs. https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=overview.process&ApplNo=212122. Published July 2020. Accessed 1 September 2020. 
  4. Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2020. Global Strategy for the Diagnosis, Management and Prevention of COPD. GOLD. https://goldcopd.org/. Accessed 1 September 2020.
  5. Centers for Disease Control and Prevention. Smoking and Respiratory Diseases. CDC. https://goldcopd.org/wp-content/uploads/2020/03/GOLD-2020-POCKET-GUIDE-ver1.0_FINAL-WMV.pdf. Published 2014. Accessed 1 September 2020. 
  6. Rabe KF, Martinez FJ, Ferguson GT, et al. Triple Inhaled Therapy at Two Glucocorticoid Doses in Moderate-to-Very-Severe COPD. N Engl J Med. 2020;383(1):35-48. 
  7. Ferguson GT, Rabe KF, Martinez FJ, et al. Triple therapy with budesonide/glycopyrrolate/formoterol fumarate with co-suspension delivery technology versus dual therapies in chronic obstructive pulmonary disease (KRONOS): a double-blind, parallel-group, multicentre, phase 3 randomised controlled trial [published correction appears in Lancet Respir Med. 2018 Oct 4] [published correction appears in Lancet Respir Med. 2019 Feb;7(2):e9]. Lancet Respir Med. 2018;6(10):747-758. 
  8. Breztri Aerosphere (budesonide, glycopyrrolate, and formoterol) [package insert]. Wilmington, DE: AstraZeneca Pharmaceuticals LP; July 2020
Published September 17th, 2020 by Dr. Dylan Kakos, PharmD
Fact Checked by Chris Riley

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