Can a steroid pack be used with Breztri (budesonide/glycopyrrolate/formoterol) for a patient with Chronic Obstructive Pulmonary Disease (COPD) exacerbation?

Using Systemic Corticosteroids with Breztri for COPD Exacerbation

Yes, a systemic corticosteroid pack (short course) can and should be used with Breztri (budesonide/glycopyrrolate/formoterol) for a patient experiencing a COPD exacerbation. 1

Rationale for Combination Therapy

• Breztri (Triple Therapy) Role:

  • Breztri is a maintenance medication containing an inhaled corticosteroid (budesonide), a long-acting muscarinic antagonist (glycopyrrolate), and a long-acting β-agonist (formoterol) 2
  • It's designed for ongoing COPD management, not acute exacerbation treatment 3

• Systemic Corticosteroid Role:

  • For acute exacerbations, systemic corticosteroids accelerate recovery and reduce relapse risk 4
  • Guidelines recommend systemic corticosteroids for treating COPD exacerbations to prevent subsequent exacerbations within 30 days 5

Recommended Corticosteroid Regimen

• Dosage: 40 mg oral prednisone daily for 5 days (equivalent to approximately 32 mg methylprednisolone) 1
• Administration: Oral administration is equally effective as IV for COPD exacerbations and is the preferred route 6
• Duration: Short course (5 days) is sufficient and minimizes adverse effects 1

Important Considerations

• Continue Breztri: Maintain the patient's regular Breztri dosing during the exacerbation treatment

• Monitor for Side Effects: Common adverse effects of short-term systemic corticosteroids include:

  • Hyperglycemia (especially in diabetic patients)
  • Insomnia
  • Weight gain
  • Anxiety or mood disturbances
  • Fluid retention 1

• Avoid Long-term Systemic Corticosteroids: Guidelines explicitly recommend against using systemic corticosteroids beyond 30 days following an exacerbation 5

  • Long-term use is associated with worse mortality and skeletal muscle myopathy 4

Follow-up Care

• After the exacerbation resolves, discontinue the systemic corticosteroid pack
• Continue maintenance therapy with Breztri
• Consider reassessing overall COPD management if exacerbations are frequent
• Schedule follow-up within 3-6 months with repeat spirometry to assess treatment response 1

Clinical Pearls

• The inhaled corticosteroid in Breztri (budesonide) is not sufficient for treating acute exacerbations
• Short-course systemic corticosteroids provide benefits that outweigh the risks in acute exacerbations
• Oral prednisolone is as effective as IV administration, making it the preferred route 6
• Antibiotics may also be considered if there is increased sputum purulence 1