Breztri alternatives: What can I take instead of Breztri?

Compare Breztri Aerosphere alternatives | Trelegy Ellipta | Duaklir Pressair | Stiolto Respimat | Anoro Ellipta | Perforomist | Natural alternatives | How to switch meds

Breztri Aerosphere is a brand-name metered-dose inhaler manufactured by AstraZeneca to treat chronic obstructive pulmonary disease (COPD). Alternatives may be necessary for an individual unable to use a metered-dose inhaler, has experienced a prior allergic reaction, or is taking a medication that may negatively interact with Bretzi. Reviewing medications with a pharmacist or medical doctor is essential to identify additional drug interactions that may worsen or cause side effects. 

RELATED: What causes COPD? Diagnosis, prevention, and treatment

What can I take in place of Breztri Aerosphere?

Treating COPD is like following a step-by-step plan. First, doctors look at how bad your breathing problems are and how often you have flare-ups. Then, they use a guide called the Global Initiative for Chronic Obstructive Lung Disease (GOLD) report to decide which medicines might work best for you at the start. After treatment, it’s important to watch how you’re feeling and any flare-ups you might have had. This helps your healthcare team ensure you’re doing well and adjust your treatment if needed. 

All COPD patients should minimally receive a short-acting bronchodilator, such as the prescription drug albuterol, which serves as a rescue inhaler to relieve symptoms quickly. Inhaled bronchodilators, with different effects and durations, are added based on symptom severity and past flare-ups. A combination LAMA/LABA product may be considered for low-risk patients with slightly persistent or more severe symptoms. People with COPD who have a higher chance of experiencing worsening symptoms are those who had two or more flare-ups in the past year or any flare-up that was serious enough to require a hospital stay. These patients should be offered a LAMA/LABA combination product. 

In COPD, use of LABA/ICS combinations like Symbicort (budesonide/formoterol), Advair Diskus/Advair HFA (fluticasone/salmeterol), Breo Ellipta (fluticasone furoate/vilanterol), or Dulera (mometasone/formoterol) is not encouraged because two clinical trials, the TORCH and SUMMIT trials, failed to demonstrate evidence for the efficacy of this combination when compared to placebo in reducing their primary outcome of mortality in COPD patients. 

If you need an inhaled corticosteroid, using a combination treatment called triple therapy (which includes LABA, LAMA, and ICS) works better than just using LABA and ICS together. This triple combo helps patients more with their reported outcomes, makes their lung function better, lowers the chances of flare-ups, and reduces the risk of death from all causes, especially in patients at higher risk. Breztri Aerosphere and currently only one other product approved by the Food and Drug Administration (FDA), Trelegy Ellipta, offers three classes of medications in one product. Low ICS doses should be used to limit the risk of pneumonia since corticosteroids can change the mix of bacteria in your airways, leading to oral candidiasis (thrush) and increase the risk of pneumonia.

When using medication 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 molecules within the same class may be important to achieving pharmacotherapy goals. 

Other alternatives to Breztri 

Beta-2 Agonists

• Short-acting beta agonist
  • Proventil HFA (albuterol) 
  • Xopenex HFA (levalbuterol) 
• Long-acting beta agonists
  • Brovana (arformoterol) 
  • Perforomist (formoterol) 
  • Striverdi Respimat (olodaterol) 
  • Serevent Diskus (salmeterol) 

Anticholinergics

• Short-acting muscarinic antagonists
  • Atrovent HFA (ipratropium bromide) 
• Long-acting muscarinic antagonists
  • Tudorza Pressair (aclidinium bromide) 
  • Spiriva Handihaler (tiotropium) 
  • Incruse Ellipta (umeclidinium) 
  • Yupelri (revefenacin) 

Inhaled Corticosteroids

• Arnuity Ellipta (fluticasone furoate) 
• Fluticasone propionate 
• Pulmicort Flexhaler (budesonide)

Top 5 Breztri alternatives

The following are some of 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 one device in the United States that the U.S. Food and Drug Administration has approved. 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), which differs from Breztri Aerosphere and is supplied as a metered-dose inhaler (MDI). Metered-dose inhalers require patient coordination of breath and actuation, which may be problematic in patients with reduced grip strength, as seen with 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 only requires a once-daily inhalation instead of a twice-daily dosing regimen. For those struggling with compliance, this may make Trelegy Ellipta more appealing. Individuals with severe hypersensitivity to milk proteins should not receive Trelegy Ellipta, given it contains a powder form of lactose. 

RELATED: Trelegy Ellipta dosage, forms, and strengths

2. Duaklir Pressair (formoterol/aclidinium)

Duaklir Pressair is a dry-powder inhaler that combines the LABA, formoterol, and a LAMA, aclidinium. This combination of inhaled bronchodilators may be an alternative to Breztri Aerosphere for those unable to use a metered-dose inhaler effectively. Duaklir Pressair only offers a dual combination of LABA/LAMA, so if used as an alternative to Breztri Aerosphere in patients continuing to require an inhaled corticosteroid, two inhalers will be necessary. Withdrawing an inhaled corticosteroid from a patient’s regimen is also a consideration for those who develop considerable side effects or pneumonia. Duaklir Pressair may also be considered an alternative for individuals who cannot tolerate the inhaled corticosteroid in Breztri Aerosphere. Breztri Aerosphere contains budesonide, which is not as strong as fluticasone. If you need a stronger corticosteroid, consider using Duaklir Pressair alongside a separate inhaler containing fluticasone, like fluticasone propionate HFA, ArmonAir Digihaler, or Arnuity Ellipta. Like Trelegy Ellipta, Duaklir Pressair also contains a powder form of lactose and should be avoided in individuals allergic to milk.  

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 like Breztri Aerosphere. The soft mist inhaler device releases a low-velocity aerosol mist that patients can slowly inhale over a longer period than MDIs or DPIs. This inhalation device improves ease of use over an MDI and DPI since the coordination requirement for actuation and inhalation is minimized. The soft mist may also decrease oropharyngeal deposition and improve pulmonary distribution. However, up to 12% of patients reported nose and throat infections like 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, like a diagnosis of 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 like Stiolto Respimat as it contains a LABA and a LAMA. Still, the specific medications in these drug classes differ—its LABA is vilanterol, and its LAMA is umeclidinium. Anoro Ellipta is also similar to Stiolto Respimat in that it allows for once-daily dosing but does contain a milk protein and, therefore, should be avoided in patients with severe allergic reactions to lactose. Stiolto Respimat caused back pain in up to 4% of individuals taking this medication in clinical trials, which was not reported 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.

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

Nebulization is another route of inhalation administration. Perforomist, Yupelri, and Pulmicort are available in solutions that can be administered via nebulizer but are not available in a combination product and 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 the actuation and breathing required with 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 advancement of COPD. Other risk factors include exposure to air pollutants, genetic predispositions, and respiratory infections. For those who smoke 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 like exercise training, education, and self-management strategies to improve physical and mental health, aiming for long-term health improvement. These programs are encouraged for individuals diagnosed with COPD to understand their condition better. 

While some over-the-counter dietary supplements, such as those rich in antioxidants, omega-3, and vitamin D, may improve exercise tolerance and reduce inflammation, the best natural approach to COPD management includes a healthy diet rich in fruits and vegetables rich in vitamins A, C, and E, maintenance of an exercise program, and adequate sleep. These must be practiced in conjunction with the prescription drugs required for symptom and exacerbation management. Standard pharmacologic treatment should only be stopped after consulting with a healthcare provider. 

How to switch to a Breztri Aerosphere alternative

Managing COPD with medications is essential for alleviating symptoms such as breathlessness and mitigating the likelihood of COPD flare-ups. Therefore, discontinuing any medication 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. Since routine monitoring of COPD treatments is a key part of managing the condition, reviewing medications and exploring different options is an ongoing process.