From the Guidelines
For a patient with lung disease requiring an inhaler but who has allergies to Breo, Symbicort, and Advair, the most suitable alternative option is Anoro Ellipta (umeclidinium/vilanterol) or Stiolto Respimat (tiotropium/olodaterol), as these do not contain the components that the patient is allergic to, according to the most recent guidelines 1.
Key Considerations
- The choice of inhaler depends on the underlying condition, whether it's COPD or asthma, as well as the severity of symptoms and the specific component causing the allergic reaction.
- If the allergy is specific to certain components rather than all inhaled corticosteroids, options like Trelegy Ellipta (fluticasone furoate/umeclidinium/vilanterol) could be considered.
- Non-combination inhalers such as LAMA options (Spiriva or Incruse Ellipta) or LABA options (Serevent or Striverdi) are also viable alternatives.
- For patients with asthma who cannot use ICS/LABA combinations, adding montelukast (Singulair) 10mg daily to a LAMA or LABA is a potential strategy, as suggested by guidelines 1.
Important Factors
- Identifying whether the allergy is to the active ingredients or to propellants/excipients in these devices is crucial for selecting the appropriate alternative.
- A rescue inhaler like albuterol should still be used as needed for breakthrough symptoms, regardless of the maintenance therapy selected, as recommended by various guidelines 1.
Treatment Approach
- The treatment approach should prioritize reducing the risk of acute exacerbations, improving lung function, and enhancing health-related quality of life, while minimizing the risks associated with the therapies, such as the increased risk of pneumonia with ICS use 1.
- Regular monitoring and adjustment of the treatment plan based on the patient's response and any side effects experienced are essential for optimal management.
From the FDA Drug Label
ALVESCO is a prescription medicine used for the control and prevention of asthma in adults and children 12 years of age and older. Do not use ALVESCO if you are allergic to ciclesonide or any of the ingredients in ALVESCO.
The patient has an allergy to Breo, Symbicort, and Advair, but there is no information about an allergy to ciclesonide. Ciclesonide (ALVESCO) may be considered as an alternative option for the patient, but it is crucial to confirm that the patient is not allergic to ciclesonide or any of its ingredients. It is also essential to consult with a healthcare provider to determine the best course of treatment. 2
From the Research
Alternative Inhaler Options
Given the allergy to Breo, Symbicort, and Advair, alternative inhaler options can be considered.
- Umeclidinium/vilanterol (UMEC/VI) is a potential option, as it has been compared to fluticasone propionate/salmeterol (FP/SAL), budesonide/formoterol (B/F), and tiotropium (TIO) in patients with COPD 3.
- Budesonide/formoterol (BFC) is another option, which has been compared to fluticasone propionate/salmeterol (FSC) in terms of cost, therapy adherence, and related healthcare utilization 4.
Efficacy Comparison
Studies have compared the efficacy of different inhaler combinations:
- Budesonide/formoterol (BF) versus fluticasone/salmeterol (FS) in patients with moderate-to-severe COPD, showing reduced exacerbations, hospitalizations, and pneumonia with BF 5.
- Budesonide/formoterol versus salmeterol/fluticasone in COPD patients, indicating a lower incidence of pneumonia adverse events and serious adverse events with budesonide/formoterol 6.
Considerations
When selecting an alternative inhaler, consider the patient's specific needs and medical history: