Can Breztri (budesonide, glycopyrronium, and formoterol) be used for the treatment of Chronic Obstructive Pulmonary Disease (COPD)?

Breztri for COPD Management

Breztri (budesonide/glycopyrronium/formoterol) is indicated and effective for maintenance treatment of Chronic Obstructive Pulmonary Disease (COPD), providing superior exacerbation reduction compared to dual therapies. 1

Efficacy and Clinical Benefits

Breztri combines three key components for COPD management:

• Budesonide (inhaled corticosteroid)
• Glycopyrronium (long-acting muscarinic antagonist/LAMA)
• Formoterol (long-acting beta-agonist/LABA)

This triple therapy has demonstrated significant advantages:

• Reduces moderate/severe COPD exacerbation rates more effectively than dual therapies 1
• Improves lung function to a greater extent than budesonide/formoterol or glycopyrronium/formoterol 1
• Provides beneficial effects on:
  • Dyspnea (breathlessness)
  • Rescue medication requirements
  • Health-related quality of life
  • Reduces all-cause mortality risk 1

Patient Selection for Triple Therapy

Breztri is most appropriate for:

• Patients with moderate to very severe COPD 2
• Those with inadequate control on dual therapy (either ICS/LABA or LAMA/LABA) 1
• Patients experiencing exacerbations despite optimal dual therapy 2

Treatment Algorithm Based on Disease Severity

1. Mild COPD (few symptoms):

   • No drug treatment if asymptomatic
   • Short-acting bronchodilators as needed for symptoms 3, 4

2. Moderate COPD:

   • Single long-acting bronchodilator (LAMA or LABA) 3, 4
   • Most patients can be controlled on a single drug 3

3. Severe COPD:

   • Combination therapy with LAMA/LABA if single therapy inadequate 3, 4
   • Consider triple therapy with Breztri when dual therapy fails to control symptoms or exacerbations 1, 2

Safety Considerations

Breztri is generally well tolerated with a safety profile similar to its individual components 1. However, important safety considerations include:

• Increased risk of pneumonia compared to dual bronchodilator therapy 2
• Common side effects include dysphonia and candidiasis 2
• Not indicated for acute deteriorations of COPD 5

Clinical Pearls and Pitfalls

1. Device Selection: Breztri uses co-suspension delivery technology via a pressurized metered-dose inhaler, which may benefit patients with adherence or technique issues 2

2. Avoid in Asthma: Formoterol component is not indicated for asthma management without appropriate controller medication 5

3. Monitoring: Regular assessment of response is essential, including:

   • Exacerbation frequency
   • Symptom control
   • Lung function
   • Side effects, particularly pneumonia

4. Dual vs. Triple Therapy: The American Thoracic Society notes ongoing controversy regarding optimal timing for escalation from dual to triple therapy 4, but evidence supports using triple therapy in patients inadequately controlled on dual therapy 1

5. Mortality Benefit: Higher-dose Breztri has shown decreased mortality compared to dual bronchodilator therapy, though further studies are needed to confirm this potential benefit 2

Breztri represents an important advancement in COPD management, providing a convenient single-inhaler triple therapy option for patients requiring escalation beyond dual therapy, with demonstrated benefits for exacerbation reduction and improved quality of life.