Should I continue home Breztri (budesonide, glycopyrrolate, and formoterol) and Duoneb (ipratropium and albuterol) during an acute exacerbation of Chronic Obstructive Pulmonary Disease (COPD) requiring hospital admission?

Management of Home Medications During COPD Exacerbation Requiring Hospitalization

Yes, you should continue home Breztri (budesonide, glycopyrrolate, and formoterol) and Duoneb (ipratropium and albuterol) during an acute exacerbation of COPD requiring hospital admission, as these medications provide essential bronchodilation and anti-inflammatory effects that support recovery.

Rationale for Continuing Home Bronchodilator Therapy

Short-acting bronchodilators are a cornerstone of COPD exacerbation management, and continuing the patient's established regimen provides several benefits:

• Short-acting bronchodilators (β-agonists and anticholinergics) are effective in increasing FEV1 and reducing breathlessness during exacerbations 1
• Regular administration of these medications is necessary during exacerbations as their effects last only 4-6 hours 1
• Continuing maintenance therapy helps prevent deterioration in lung function during hospitalization

Medication-Specific Considerations

Breztri (budesonide/glycopyrrolate/formoterol)

• Contains both long-acting bronchodilators (LAMA/LABA) and inhaled corticosteroid
• Clinical evidence shows Breztri reduces exacerbation rates by 26-35% compared to formoterol alone 2
• Continuing this medication supports faster recovery and may reduce risk of subsequent exacerbations

Duoneb (ipratropium/albuterol)

• Provides both short-acting anticholinergic and β-agonist effects
• Particularly effective during acute exacerbations for immediate symptom relief
• Can be administered via nebulizer, which is more convenient during acute illness 1

Hospital Management Protocol

1. Continue home medications:

   • Maintain Breztri at prescribed home dosage
   • Continue Duoneb treatments, potentially at increased frequency during acute phase

2. Add additional treatments as needed:

   • Systemic corticosteroids (prednisolone 30 mg daily for 7-14 days) 1, 3
   • Antibiotics if indicated (purulent sputum, increased sputum volume, increased breathlessness) 1
   • Supplemental oxygen to maintain saturation 88-92% 3

3. Monitor response:

   • Assess for improvement in dyspnea, oxygen saturation, and lung function
   • Watch for potential drug interactions or adverse effects

Important Considerations and Potential Pitfalls

• Delivery method may change: During hospitalization, nebulized treatments may be preferred over inhalers for more reliable medication delivery 1

• Avoid abrupt discontinuation: Stopping maintenance therapy can lead to worsening symptoms and prolonged recovery time

• Medication reconciliation is critical: Studies show improved medication reconciliation at admission reduces rehospitalization rates (from 36.4% to 15.4%) 4

• Plan for discharge: Ensure continuation of appropriate medications post-discharge, as one-year readmission rates for COPD exacerbations are high (16.7%) 5

• Consider triple therapy: If not already on triple therapy, hospitalization for exacerbation may be an appropriate time to consider escalation 5

By maintaining home bronchodilator therapy while adding appropriate acute treatments, you provide optimal respiratory support during the exacerbation while maintaining continuity of care, which supports better outcomes and reduced risk of treatment failure.