Prescribing Breztri Inhaler
Breztri (budesonide, glycopyrrolate, and formoterol) should be prescribed as 2 inhalations once daily with a quantity of one inhaler to be dispensed. This triple therapy inhaler is designed for once-daily dosing in the management of COPD.
Prescription Format
When writing a prescription for Breztri inhaler, include the following elements:
- Medication Name: Breztri Aerosphere (budesonide 160 mcg, glycopyrrolate 9 mcg, formoterol fumarate 4.8 mcg)
- Sig (Instructions): Inhale 2 puffs by mouth once daily
- Quantity: 1 inhaler (120 inhalations)
- Refills: As appropriate for patient's condition (typically 1-3)
Administration Instructions
For optimal therapeutic benefit, provide these additional instructions to the patient:
- Shake well before each use
- Exhale fully before placing the mouthpiece between lips
- Inhale deeply and slowly while pressing down on the canister
- Hold breath for 5-10 seconds after inhalation
- Wait approximately 30 seconds between the two inhalations
- Rinse mouth with water after use to prevent oral candidiasis
Clinical Evidence
Breztri Aerosphere is a fixed-dose combination of an inhaled corticosteroid (budesonide), a long-acting muscarinic antagonist (glycopyrrolate), and a long-acting β2-agonist (formoterol) that has demonstrated efficacy in reducing COPD exacerbations 1. The ETHOS trial showed that this triple therapy significantly reduced the rate of moderate or severe COPD exacerbations compared to dual therapies 2.
Important Considerations
- Patient Selection: Appropriate for patients with moderate-to-very-severe COPD who have had at least one exacerbation in the past year
- Monitoring: Regular assessment of symptom control and lung function
- Adverse Effects: Monitor for potential adverse effects including pneumonia (3.5-4.5% incidence), oral candidiasis, and bronchospasm 2
- Contraindications: Not for relief of acute bronchospasm or asthma without concomitant use of a controller medication
Common Pitfalls to Avoid
- Incorrect Dosing Frequency: Unlike some inhalers that require twice-daily dosing, Breztri is administered once daily
- Inadequate Patient Education: Ensure patients understand this is a maintenance medication, not a rescue inhaler
- Poor Inhaler Technique: Demonstrate proper technique and have the patient demonstrate it back
- Missing Mouth Rinsing: Emphasize the importance of rinsing the mouth after use to prevent oral fungal infections
Following these guidelines will help ensure appropriate prescribing of Breztri inhaler for patients with COPD requiring triple therapy.