Can a patient with asthma or COPD take Airsupra (albuterol and budesonide) with the Ellipta device, which is designed for Breo (fluticasone furoate and vilanterol)?

Device Incompatibility: Airsupra and Ellipta Cannot Be Used Together

Airsupra (albuterol/budesonide) and the Ellipta device are completely incompatible—Airsupra is delivered via a pressurized metered-dose inhaler (pMDI), while Ellipta is a dry powder inhaler designed exclusively for medications like Breo (fluticasone furoate/vilanterol). These are fundamentally different delivery systems that cannot be interchanged.

Critical Device-Specific Constraints

Airsupra Delivery System

• Airsupra is formulated as a pressurized metered-dose inhaler (pMDI) containing albuterol sulfate (90 mcg) and budesonide (80 mcg) per actuation 1
• The medication is suspended in a propellant system that requires the pMDI mechanism to aerosolize the drug particles 1
• Cannot be transferred to any other device type—the formulation is device-specific 1

Ellipta Device Specifications

• The Ellipta is a blister strip dry powder inhaler with medium resistance, designed to deliver medications as dry powder formulations across a range of inspiratory flow rates 2
• Ellipta delivers fluticasone furoate/vilanterol (Breo), umeclidinium/vilanterol, or fluticasone furoate/umeclidinium/vilanterol in once-daily dosing regimens 2, 3
• The device physically cannot accommodate pMDI canisters or liquid formulations—it requires pre-loaded blister strips containing dry powder 2

Why This Matters Clinically

For Asthma Patients

• Patients requiring both rescue and maintenance therapy should use Airsupra as prescribed via its own pMDI device, and if additional maintenance therapy is needed, consider separate controller medications 4
• The 2020 National Asthma Education and Prevention Program guidelines recommend budesonide/formoterol for SMART protocol (single maintenance and reliever therapy) in patients ≥12 years at steps 3-4, which serves a similar dual-purpose role as Airsupra 4
• If a patient is already on Breo via Ellipta and needs rescue therapy, they must use a separate short-acting beta-agonist (SABA) inhaler—Airsupra would replace both the Breo and the SABA, not supplement them 4

For COPD Patients

• The 2023 Canadian Thoracic Society guidelines recommend LAMA/LABA dual therapy as initial maintenance for symptomatic COPD patients with FEV1 <80% predicted 5
• Breo (fluticasone furoate/vilanterol) via Ellipta is appropriate for COPD patients at high risk of exacerbations, providing once-daily ICS/LABA combination therapy 3, 6
• Airsupra serves as both rescue and anti-inflammatory therapy in a single inhaler for asthma—it is not indicated for COPD maintenance therapy 1

Practical Clinical Algorithm

If Patient Currently Uses Breo via Ellipta:

1. Continue Breo via Ellipta device as prescribed 3
2. Add separate SABA pMDI (albuterol alone) for rescue therapy—do NOT attempt to use Airsupra alongside Breo 4
3. Monitor for adequate symptom control and exacerbation frequency every 2-6 weeks 1

If Considering Switch from Breo to Airsupra:

1. Determine if patient has asthma (Airsupra indicated) or COPD (Airsupra not indicated) 4, 1
2. For asthma patients: Airsupra can replace both maintenance ICS/LABA and rescue SABA, eliminating need for Breo 4
3. For COPD patients: Continue Breo via Ellipta; Airsupra is not a substitute 5

If Patient Has Both Devices:

1. This represents either a prescribing error or patient confusion—clarify the treatment plan immediately 1
2. Verify diagnosis (asthma vs. COPD vs. overlap syndrome) 4
3. Consolidate to single appropriate regimen based on diagnosis and severity 5, 4

Common Pitfalls to Avoid

• Never attempt to transfer medication from one device type to another—formulations are device-specific and non-interchangeable 2
• Do not assume all inhalers are compatible—pMDIs, dry powder inhalers, and soft mist inhalers are distinct delivery systems 2
• Failing to educate patients on proper device technique for each inhaler type leads to therapeutic failure—pMDI requires slow inhalation with coordination, while Ellipta requires rapid, forceful inhalation 2, 1
• Using Airsupra in COPD patients without asthma overlap is off-label and not supported by guidelines 5, 4