Breztri Aerosphere is a combination inhaler that is used to treat chronic obstructive pulmonary disease (COPD). Breztri consists of budesonide (an inhaled corticosteroid), glycopyrrolate (an anticholinergic), and formoterol fumarate (a long-acting beta-agonist). Breztri may cause or worsen infections, so it is important to pay attention to any signs of an infection and alert your healthcare provider if an infection does occur.
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Breztri Aerosphere
Generic components: Budesonide, glycopyrrolate, and formoterol fumarate
There is no generic version of Breztri Aerosphere commercially available
COPD maintenance treatment
Inhaled corticosteroid, anticholinergic, and long-acting beta-agonist
Inhalation aerosol
By oral inhalation
Breztri Aerosphere is used as a maintenance treatment for COPD. It should not be used to treat an acute COPD flare-up or asthma.
Breztri Aerosphere is only used for the maintenance treatment of COPD. It should not be used to treat asthma or to relieve sudden breathing problems.
Before starting Breztri Aerosphere, tell your healthcare provider about all medical conditions that you have, any other medications that you take, and any infections that you may have or be at risk of getting.
Do not take any other medications that contain an anticholinergic or long-acting beta-agonist while taking Breztri Aerosphere.
After inhaling a Breztri Aerosphere dose, rinse your mouth with water and then spit it out in order to reduce the risk of getting oral thrush.
Prime your inhaler before using it for the first time and after rinsing the actuator. Rinse the yellow actuator once weekly.
Inhalation aerosol:
160 mcg of budesonide, 9 mcg of glycopyrrolate, and 4.8 mcg of formoterol fumarate
Maintenance treatment of COPD: two oral inhalations of Brestri Aerosphere twice daily
Breztri Aerosphere
10.7gm of 160-9-4.8mcg/act (120 inhalations) inhaler
Prime each inhaler before using it for the first time. Remove the mouthpiece, shake the inhaler well, and spray one test-puff into the air facing away from you. Shake and spray it a total of four times.
Remove the mouthpiece and check to see if there are any foreign objects which should be removed before use.
Shake the inhaler well before each puff, breathe out fully, place the mouthpiece into the mouth, and close the lips around the mouthpiece, then start to breath in deeply and slowly while spraying one puff. Continue breathing in until you cannot anymore, then hold your breath for as long as you can, up to 10 seconds. Repeat this for the second puff.
Put the mouthpiece cover back on. Rinse your mouth with water and spit out the water. Do not swallow the water.
Rinse the yellow actuator once weekly by removing it from the canister and running it under warm water for 30 seconds through the mouthpiece and 30 seconds through the top of the actuator. Do not get the canister wet. Look into the actuator and repeat the rinsing process if there is any build-up. Let the actuator air dry; do not use a towel or tissue to dry it.
The inhaler should be reprimed with two test-puffs after rinsing the yellow actuator if it is dropped, or if it is not used for more than seven days.
The puff indicator tells you how many puffs are left in the inhaler. When it reaches the yellow zone, it is time to order a new inhaler. It will reach the red zone when the number shows 0. Throw away the inhaler once the puff indicator shows 0 or if it has been three months since it was removed from the foil pouch.
If you miss a dose of Breztri, take it as soon as you remember it. However, if it is closer to the next dose, skip the missed dose and take the next scheduled dose. Do not double a dose due to missing one previously.
Breztri Aerosphere is contraindicated in those who have hypersensitivity to budesonide, glycopyrrolate, formoterol fumarate, or any of the excipients in the inhaler.
Breztri Aerosphere should not be used in combination with another medication containing a long-acting beta-agonist or anticholinergic.
Breztri Aerosphere may increase the risk of a fungal infection of the mouth and throat.
There is an increased risk of pneumonia occurring in COPD patients, and Breztri Aerosphere may worsen any existing infections.
There is a risk of impaired adrenal function when switching from an oral steroid to Breztri Aerosphere. Patients should be tapered slowly when discontinuing oral steroids.
Hypercorticism and adrenal suppression may occur in certain susceptible people or with very high doses of Breztri Aerosphere. Take your medication exactly as prescribed.
Caution should be taken in those with a history of heart disease, decreased bone mineral density, glaucoma, cataracts, urinary retention, seizure disorders, thyroid disorders, low potassium levels (hypokalemia), and diabetes.
Strong inhibitors of CYP3A4, a liver enzyme, and adrenergic drugs may increase the effects of Breztri Aerosphere.
Diuretics, xanthine derivatives, or steroids may increase the risk of hypokalemia.
Monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants should be used with extreme caution because they can increase the risk of heart effects.
Beta-blockers can block the effects of the long-acting beta-agonist in Breztri Aerosphere.
Talk to your healthcare provider if you notice that your breathing problems get worse, you need to use your rescue inhaler more often than usual, your rescue inhaler does not work as well as it used to, or there are any side effects that bother you or will not go away. Seek medical help right away if you experience signs of a severe allergic reaction or if you experience pneumonia symptoms, such as an increase in mucus, change in mucus color, fever, chills, increased cough, or increased breathing problems.
Serious side effects:
Pneumonia
Fungal infection in the mouth or throat
Weakened immune system
Reduced adrenal function
Sudden breathing problems immediately after inhaling Breztri Aerosphere
A serious allergic reaction, such as rash, hives, breathing problems, or swelling of the face, mouth, and tongue
Heart effects, such as an increase in blood pressure, chest pain, or a fast or irregular heartbeat
Nervous system effects, such as tremors or nervousness
Osteoporosis
New or worsening eye problems, including narrow-angle glaucoma and cataracts
Urinary retention
High blood sugar or low potassium levels
Less serious side effects:
Upper respiratory tract infections
Back pain
Joint pain
Flu
Headache
Muscle spasms
Cough
Sinus inflammation
Diarrhea
Hoarseness
Nausea
Difficulty sleeping
Highlights of prescribing information, AstraZeneca (2022)
Josephine Bawab, Pharm.D., graduated from Virginia Commonwealth University School of Pharmacy. She began working in community pharmacy in 2012 and has worked for multiple chain pharmacies since then. She is passionate about helping patients and precepting students. She currently works and resides in Virginia, where she is just a few minutes away from the beach.
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