Can Breztri Be Used for Asthma?
No, Breztri (budesonide/glycopyrrolate/formoterol) should not be used for asthma—it is FDA-approved exclusively for COPD maintenance treatment, not asthma. 1
Why Breztri Is Not Appropriate for Asthma
FDA Indication Limitation
- Breztri is a triple-therapy combination (ICS/LAMA/LABA) specifically approved only for maintenance treatment of chronic obstructive pulmonary disease (COPD), not asthma 1
- The formulation contains glycopyrrolate (a long-acting muscarinic antagonist/LAMA), which is not part of standard asthma treatment algorithms 1
Asthma Guidelines Do Not Support Triple Therapy with LAMA
- Current asthma guidelines recommend ICS/LABA combinations (like budesonide/formoterol), but do not include LAMA as standard therapy 2
- For persistent asthma requiring step 3 or higher care, the preferred approach is ICS combined with a LABA (such as formoterol or salmeterol), not triple therapy 2, 3
- Long-acting β2-agonists must always be combined with inhaled corticosteroids in asthma and never used as monotherapy 2, 3, 4
What Should Be Used Instead for Asthma
For Moderate to Severe Persistent Asthma
- Budesonide/formoterol combination (without glycopyrrolate) is the appropriate choice 4, 5
- Standard dosing: 160/4.5 mcg, two inhalations twice daily for adults and children ≥12 years 4
- This provides both anti-inflammatory effects (budesonide) and bronchodilation (formoterol) with duration of at least 12 hours 4
SMART Regimen Option
- Budesonide/formoterol can be used as both maintenance and reliever therapy (SMART regimen) in steps 3-4 asthma 6, 5
- SMART reduces severe exacerbations by 30% compared to fixed-dose ICS/LABA plus short-acting β2-agonist reliever 6
- This approach reduces total exacerbations and hospitalizations/ER visits while using less total ICS exposure 7
Stepwise Approach Based on Severity
- Step 2 (mild persistent): Low-dose ICS plus LABA 2
- Step 3 (moderate persistent): Medium-dose ICS plus LABA 2, 4
- Step 4-5 (severe persistent): High-dose ICS plus LABA, with consideration of additional controllers 2
- Step 6: May require oral corticosteroids plus high-dose ICS/LABA 2
Critical Safety Considerations
LABA Safety in Asthma
- LABAs are strictly contraindicated as monotherapy for asthma control due to safety concerns 2, 3, 4
- Must always be prescribed in combination with inhaled corticosteroids 2, 3
- Frequent use of rescue medication (>2 days/week) indicates inadequate control and requires treatment adjustment 2, 4