Breztri alternatives: What can I take instead of Breztri?

In this article:

• Breztri Aerosphere
• Trelegy Ellipta
• Bevespi Aerosphere
• Stiolto Respimat
• Anoro Ellipta
• Perforomist, Yupelri, Pulmicort
• Natural alternatives
• OTC treatments
• How to switch
• Choosing the right path

In this article

• Breztri Aerosphere
• Trelegy Ellipta
• Bevespi Aerosphere
• Stiolto Respimat
• Anoro Ellipta
• Perforomist, Yupelri, Pulmicort
• Natural alternatives
• OTC treatments
• How to switch
• Choosing the right path

Breztri Aerosphere is a brand-name metered-dose inhaler used for maintenance treatment of chronic obstructive pulmonary disease (COPD). It is a “triple therapy inhaler” containing three ingredients that help keep the airways open and prevent COPD exacerbations: an inhaled corticosteroid (budesonide) and two long-acting bronchodilators (glycopyrrolate and formoterol). Alternatives include Trelegy Ellipta, another triple therapy inhaler like Breztri, or dual therapy inhalers that share some of the same types of drugs found in Breztri. 

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What can I take instead of Breztri Aerosphere?

Treating COPD is like following a step-by-step plan and requires the right balance of medication therapy and avoidance of potential side effects. First, doctors look at the severity of breathing problems and the frequency of flare-ups. They use treatment guidelines, summarized in the Global Initiative for Chronic Obstructive Lung Disease (GOLD) report, to decide which medicines might work. After treatment, it’s important to monitor how you’re feeling and any flare-ups you might have. This helps health care providers ensure you’re doing well and adjust your treatment as needed. 

All COPD patients should have the prescription drug albuterol, which serves as a rescue inhaler to quickly relieve symptoms. Inhaled bronchodilators with different active ingredients, effects, and durations are added based on symptom severity and past flare-ups. 

In people with a low exacerbation risk but persistent symptoms despite the use of a short-acting bronchodilator, defined as those with up to one exacerbation in the prior year, a long-acting muscarinic antagonist (LAMA) or long-acting beta agonist (LABA) inhaler may be prescribed. LAMAs are generally considered superior to LABAs in preventing exacerbations and hospitalizations. Combination LAMA/LABA dual inhalers may be considered for low-risk patients with persistent or more severe symptoms. A LAMA/LABA combination product should be offered to people with COPD who have a higher chance of experiencing worsening symptoms because they have had either two or more flare-ups in the past year or at least one flare-up that was life-threatening and required a hospital stay. 

In COPD, LABA/ICS (inhaled corticosteroid) combinations like Symbicort (budesonide/formoterol), Advair Diskus/Advair HFA (fluticasone/salmeterol), Breo Ellipta (fluticasone furoate/vilanterol), or Dulera (mometasone/formoterol) are less likely to be prescribed. However, they can help people in some circumstances. Two clinical trials, the TORCH and SUMMIT trials, found that inhaled corticosteroids or a LABA/ICS inhaler reduced exacerbations but did not significantly reduce mortality in patients with COPD. 

If you need an inhaled corticosteroid, using a combination inhaler treatment called a triple therapy inhaler (which includes LABA, LAMA, and ICS) works better than just using LABA and ICS together. This triple combo has been shown to improve patients’ reported outcomes, improve lung function, lower the risk of flare-ups, and reduce the risk of all-cause mortality, especially in patients at higher risk. Breztri Aerosphere, and currently only one other product approved by the Food and Drug Administration (FDA), Trelegy Ellipta, offer all three classes of medications in a single product. Low ICS doses should be used to reduce the risk of oral thrush and pneumonia. It is also important to rinse the mouth with water after using a steroid inhaler to help prevent oral fungal infection (thrush). 

When using medications to manage a condition, it’s essential to regularly check if the treatment is working and for any barriers to successful treatment. Management of COPD is fluid and may require ongoing adjustments, both escalation and de-escalation. Switching inhaler devices or agents within the same class may be important to achieving pharmacotherapy goals. 

RELATED: Which inhalers are used to treat COPD?

Top 5 Breztri alternatives

The following are the most common alternatives to Breztri.

1. Trelegy Ellipta (fluticasone furoate/umeclidinium/vilanterol)

Trelegy Ellipta is currently the only other fixed-dose combination (FDC) triple-therapy in a single device approved by the U.S. Food and Drug Administration. While the specific make-up is unique, Trelegy Ellipta, like Breztri Aerosphere, includes an ICS (fluticasone furoate), a LAMA (umeclidinium), and a LABA (vilanterol). 

Trelegy Ellipta is available as a dry powder inhaler (DPI), whereas Breztri Aerosphere is a metered-dose inhaler (MDI). Metered-dose inhalers require patient coordination between breathing and actuation, which may be problematic in patients with reduced grip strength, as seen in arthritis. DPIs differ from MDIs because they are breath-actuated, so the coordination between breath and dose actuation is unnecessary. This may be an easier option for patients with reduced grip strength. 

Another benefit of Trelegy Ellipta over Breztri Aerosphere is that it is dosed once daily via inhalation, rather than twice daily. For those struggling with compliance, this may make Trelegy Ellipta more appealing. 

Individuals with severe hypersensitivity to milk proteins should not receive Trelegy Ellipta because it contains a powder form of lactose, which can be contaminated with milk proteins. 

RELATED: Trelegy Ellipta dosage, forms, and strengths

2. Bevespi Aerosphere (formoterol/aclidinium)

Bevespi Aerosphere is a metered-dose inhaler that contains the same LABA/LAMA combination as Breztri Aerosphere: formoterol and glycopyrrolate. What’s missing is the inhaled corticosteroid. It may be the right alternative when Breztri is working well, but daily corticosteroid use can cause side effects and increase the risk of infections. It’s also an appropriate maintenance treatment for mild COPD symptoms.

3. Stiolto Respimat (olodaterol/tiotropium)

Stiolto Respimat is a combination inhalation aerosol containing the LABA olodaterol and the LAMA tiotropium. Stiolto Respimat allows for once-daily dosing. It is available as a soft-mist inhaler, which differs from conventional MDIs such as Breztri Aerosphere. The soft mist inhaler device releases a low-velocity aerosol mist that patients can inhale more slowly over a longer period than with MDIs or DPIs. This inhalation device improves ease of use compared with an MDI and a DPI because it minimizes the coordination required for actuation and inhalation. The soft mist may also decrease oropharyngeal deposition and improve pulmonary distribution. However, up to 12% of patients reported nasal and throat infections, such as sinusitis, in clinical trials. Many fewer patients reported these effects in Breztri clinical trials. 

Stiolto Respimat should be used with caution in patients with other medical conditions, such as asthma. Long-acting beta agonists in the treatment of asthma as monotherapy have been associated with increased risks of severe exacerbations and asthma-related deaths. Patients with both COPD and asthma may require additional therapies in addition to Stiolto Respimat to avoid these adverse events. Avoidance of drug interactions with other anticholinergics can be ensured in discussion with a healthcare provider. 

RELATED: COPD vs. asthma: Which is worse?

4. Anoro Ellipta (vilanterol/umeclidinium)

Anoro Ellipta is similar to Stiolto Respimat and contains a LABA and an LAMA. Still, the specific medications in these drug classes differ. Its LABA is vilanterol, and its LAMA is umeclidinium. This combination is also available as a generic inhaler called umeclidinium-vilanterol. Anoro Ellipta is also similar to Stiolto Respimat in that it allows for once-daily dosing, but it contains powdered lactose and therefore should be avoided in patients with severe allergic reactions to milk proteins. According to clinical trials, 4% of patients taking Stiolto Respimat experienced back pain, whereas back pain was not a significant side effect in patients taking Anoro Ellipta. However, patients reported a longer list of side effects in Anoro Ellipta studies, including constipation, diarrhea, and muscle spasms. In patients with chronic pain conditions, Anoro Ellipta may be a better alternative in those requiring a combination LABA/LAMA inhaler.

RELATED: Anoro Ellipta alternatives

5. Perforomist (formoterol), Yupelri (revefenacin), Pulmicort (budesonide)

Nebulization is when medication is placed in a nebulizer machine, aerosolized into a mist, and then inhaled. Perforomist (formoterol), a LABA, Yupelri (revefenacin), a LAMA, and Pulmicort (budesonide), an inhaled corticosteroid, are available in solutions that can be administered via nebulizer. There is no combination nebulized solution, so each drug must be administered individually. Nebulization may serve as an alternative to Breztri Aerosphere when triple therapy is warranted based on patient symptomatology and exacerbations. Still, the patient cannot coordinate actuation with breathing required for MDIs, DPIs, or soft-mist inhalers. Nebulizers are also the treatment of choice in acute exacerbation as they provide quick relief.

Natural alternatives to Breztri 

Lifestyle modifications remain a cornerstone in the management plan for COPD. Tobacco smoke and vaping are key risk factors in both the development and worsening of COPD. Other risk factors include exposure to air pollutants, genetic predispositions, and respiratory infections. For those who smoke or vape tobacco, smoking cessation is the most important part of treatment. Avoiding tobacco smoke and air pollutants is important for those who do not smoke tobacco. 

Pulmonary rehabilitation includes personalized treatments such as exercise training, education, and self-management strategies to improve physical and mental health, with the aim of long-term respiratory improvement. These programs are encouraged for individuals diagnosed with COPD to understand their condition better and live a fuller, more active life. 

The best natural approach to COPD management includes a healthy diet rich in fruits and vegetables, vitamins A, C, and E, an exercise program, and adequate sleep. These must be practiced in conjunction with the prescription drugs required for symptom and exacerbation management. Continue with all prescription inhalation medications and only discontinue a medication after consulting a healthcare provider. 

Over-the-counter COPD treatments

Several over-the-counter (OTC) supplements may be potentially helpful for COPD. Some studies have identified that vitamin D levels are commonly low in individuals with COPD, and supplementation may help to minimize respiratory infections and the frequency of COPD flare-ups. Antioxidant vitamin supplementation with vitamins A, C, and E may also benefit those diagnosed with COPD by reducing exacerbations and improving symptoms. Omega-3 fatty acids may reduce inflammation, helping manage COPD symptoms. Overall, the data is inconsistent in its findings, and the decision to consume any supplementation should be based on the advice of a healthcare professional familiar with an individual’s medical history. Vitamin supplementation should be used only in addition to prescription medication, not instead of. 

How to switch to a Breztri Aerosphere alternative

Managing COPD with medications is essential for alleviating symptoms such as breathlessness and decreasing the likelihood of COPD flare-ups and hospitalizations. Therefore, discontinuing any drug used to manage COPD should only occur under the direct guidance and supervision of a healthcare professional. A well-defined plan for alternative treatments or other medically suitable options must be in place, or worsening respiratory function and hospitalization may result. Since routine monitoring of COPD treatments is a key part of managing the condition, reviewing medications and exploring different options is an ongoing process.

Choosing the right path for COPD treatment

After a diagnosis of COPD, it is important to closely follow the advice of a healthcare provider to develop an individualized treatment plan. Be honest with your provider about the type and frequency of symptoms you experience so the appropriate regimen can be prescribed, ranging from a short-acting beta-2 agonist inhaler to triple therapy such as Breztri Aerosphere. If the prescribed medication is too expensive, let the pharmacist and your physician know so they can prescribe an alternative. Reviewing a list of respiratory medications for each insurance copay tier is very helpful. With the number of options available, unique regimens can be developed that consider many aspects, like delivery modality, availability as a single inhaler versus multiple inhalers, frequency of administration, and even cost.