Recommended Dosage of Breztri for Severe COPD
The recommended dosage of Breztri (budesonide/glycopyrrolate/formoterol fumarate) for severe COPD is 320/18/9.6 μg administered as two inhalations twice daily. 1, 2
Triple Therapy Rationale for Severe COPD
- Triple therapy combining an inhaled corticosteroid (ICS), long-acting muscarinic antagonist (LAMA), and long-acting β2-agonist (LABA) is recommended for patients with severe COPD who continue to experience exacerbations despite optimal bronchodilator therapy 3
- For patients with severe COPD (FEV₁ <50% predicted) and a history of repeated exacerbations, triple therapy provides superior control of symptoms and reduction in exacerbation rates compared to monotherapy or dual therapy 4
- The combination of budesonide/glycopyrrolate/formoterol in a single inhaler simplifies administration and may improve adherence compared to using multiple inhalers 1
Clinical Benefits of Breztri in Severe COPD
- Breztri 320/18/9.6 μg has been shown to reduce the mean number of severe exacerbations compared to placebo and LABA monotherapy 1
- Triple therapy with budesonide/glycopyrrolate/formoterol improves lung function with significant increases in FEV₁ compared to placebo and ICS monotherapy 1, 2
- Morning and evening peak expiratory flow (PEF) improvements are maintained over 12 months with triple therapy 5
- Symptom scores and use of rescue β2-agonists are significantly decreased with triple therapy compared to placebo and ICS monotherapy 5
Administration Guidelines
- Breztri should be administered as two inhalations twice daily (morning and evening) 2
- The inhaler should be shaken well before each use to ensure proper medication delivery 2
- Patients should be instructed on proper inhaler technique to ensure optimal drug delivery to the lungs 3
- Rinsing the mouth after use is recommended to reduce the risk of oropharyngeal candidiasis 4
Monitoring and Follow-up
- Regular assessment of symptom control, exacerbation frequency, and lung function should be performed to evaluate treatment response 3
- Monitor for potential adverse effects, particularly pneumonia, which has a higher incidence with ICS-containing regimens 4
- The number needed to treat is four patients for one year to prevent one moderate to severe exacerbation with triple therapy versus dual bronchodilator therapy 4
- The number needed to harm is 33 patients for one year to cause one pneumonia, indicating a favorable risk-benefit ratio for triple therapy in appropriate patients 4
Special Considerations
- High doses of ICS are not typically necessary to achieve optimum benefit in COPD, as shown by a relatively flat dose-response curve 4
- For patients who cannot tolerate the 320/18/9.6 μg dose, a lower dose of 160/18/9.6 μg may be considered while monitoring for efficacy 2
- In network meta-analyses, Breztri has shown comparable efficacy to other ICS/LAMA/LABA fixed-dose combinations in reducing exacerbations and improving lung function and symptoms 1
Common Pitfalls and Caveats
- Ensure proper diagnosis of COPD versus asthma, as treatment approaches differ 3
- Assess for and address modifiable risk factors such as smoking, which should be discontinued regardless of medication regimen 3
- Triple therapy should not be used as initial therapy but reserved for patients who remain symptomatic or continue to have exacerbations despite optimal bronchodilator therapy 3
- Pneumonia risk is increased with ICS-containing regimens, particularly in patients with severe disease 4