In a patient without COPD or asthma who has respiratory syncytial virus infection, should Breo (fluticasone propionate/formoterol) be discontinued?

Breo Should Be Discontinued in Patients Without COPD or Asthma Who Have RSV

In patients without COPD or asthma, Breo (fluticasone propionate/formoterol) has no therapeutic indication and should be discontinued immediately during RSV infection. The medication is specifically approved and studied only for maintenance treatment of COPD and asthma, not for acute viral respiratory infections in otherwise healthy individuals 1, 2, 3.

Rationale for Discontinuation

Breo provides no benefit in patients without underlying chronic airway disease because:

• The inhaled corticosteroid component (fluticasone propionate) treats chronic airway inflammation characteristic of COPD and asthma, which is absent in patients without these conditions 1, 4
• The long-acting bronchodilator component (formoterol) addresses chronic bronchospasm and airflow limitation, which are not features of RSV infection in patients with normal baseline lung function 3, 4
• RSV in adults without chronic lung disease is managed with supportive care (oxygen, hydration, antipyretics) rather than maintenance respiratory medications 5

Potential Harms of Continuation

Continuing Breo unnecessarily exposes patients to risks without therapeutic benefit:

• Inhaled corticosteroids increase pneumonia risk, which is particularly concerning during an active respiratory infection 5
• Long-acting beta-agonists can cause tachycardia, tremor, and hypokalemia without providing symptomatic relief in the absence of bronchospasm 1
• The medication was studied exclusively in populations with established COPD or asthma, not in healthy individuals with acute viral infections 1, 2, 3, 4

Contrast with COPD/Asthma Patients

This recommendation differs fundamentally from management in patients with underlying chronic airway disease:

• In patients with COPD or asthma, maintenance ICS/LABA therapy should be continued during RSV infection because it treats the underlying inflammatory airway disease that viral infections exacerbate 6, 7
• Adults with asthma have 7-8 times higher risk of RSV-related hospitalization, making continuation of anti-inflammatory therapy essential 5, 6
• Discontinuing maintenance therapy in COPD/asthma patients removes the anti-inflammatory foundation needed to control exacerbations 6

Common Pitfalls to Avoid

• Do not continue Breo "just to be safe" in patients without COPD or asthma—this exposes them to medication risks without any potential benefit 5, 1
• Do not confuse short-acting rescue bronchodilators (albuterol) with maintenance therapy (Breo)—rescue inhalers may be appropriate for documented bronchospasm even in patients without chronic disease, but maintenance ICS/LABA is not 6, 7
• Verify the original indication for Breo prescription—if the patient was incorrectly prescribed Breo without documented COPD or asthma, use this opportunity to discontinue inappropriate therapy 8