How should I correctly use Breztri (budesonide/formoterol/glycopyrrolate) inhaler, including dosing, technique, storage, and missed‑dose handling?

Breztri Inhaler Instructions

Dosing

Take 2 inhalations twice daily—2 puffs in the morning and 2 puffs in the evening—for a total of 4 inhalations per day. 1

• Each inhalation delivers budesonide 160 mcg, glycopyrrolate 9 mcg (equivalent to glycopyrronium 18 mcg), and formoterol fumarate 4.8 mcg 1
• Do not take extra doses for acute symptom relief; use a separate short-acting beta-agonist (e.g., albuterol) for rescue 1
• Do not use additional long-acting beta-agonists or anticholinergic medications while on Breztri 1

Inhalation Technique

Before first use, prime the inhaler by shaking well and releasing 4 test sprays into the air away from your face. 1

Daily Use Steps:

• Remove the grey dust cap from the mouthpiece 1
• Shake the inhaler well for at least 5 seconds before each use 1
• Breathe out fully, away from the inhaler 1
• Place the mouthpiece in your mouth and close your lips around it 1
• Press down firmly on the top of the canister while breathing in slowly and deeply 1
• Hold your breath for about 10 seconds, then breathe out slowly 1
• Wait approximately 30 seconds between the two inhalations 1
• Rinse your mouth with water and spit it out after completing both inhalations to reduce the risk of oral thrush (candidiasis) 1

Use With a Spacer

If you have difficulty coordinating actuation and inhalation, a spacer device can be used and may increase drug delivery, particularly if your inhalation technique is suboptimal. 2

• Systemic and lung exposure to all three components increases when using a spacer, with the greatest benefit seen in patients with poor baseline technique 2
• Patients in the lowest exposure quartile (poorest technique) showed the largest increases in drug delivery when a spacer was added 2

Storage

Store at room temperature between 68°F to 77°F (20°C to 25°C) in a dry place away from heat and sunlight. 1

• Keep the inhaler in the unopened foil pouch until ready for use 1
• Do not store in humid environments such as bathrooms 1
• Do not expose to temperatures above 120°F (49°C), as the canister may burst 1
• Do not puncture or throw the canister into fire or an incinerator 1

Missed Dose

If you miss a dose, take it as soon as you remember, but do not take two doses at once to make up for a missed dose. 1

• Simply resume your regular twice-daily schedule 1

When to Discard

Discard the inhaler when the dose indicator reaches zero, or 3 months after opening the foil pouch for the 120-inhalation canister (3 weeks for the 28-inhalation canister), whichever comes first. 1

• The dose indicator counts down by 1 with each actuation 1
• Order a new inhaler when the pointer enters the yellow zone 1
• Do not attempt to use the inhaler when the counter shows "0" as you will not receive a full dose 1
• Never immerse the canister in water to check remaining doses ("float test") 1

Weekly Maintenance

Rinse the yellow actuator with warm water once weekly to prevent medication buildup that can block the spray. 1

• Remove the canister from the actuator before rinsing 1
• Do not allow the metal canister to get wet 1
• Allow the actuator to air-dry completely before reassembling 1
• Re-prime the inhaler with 4 test sprays after cleaning and drying 1

Important Safety Reminders

• Breztri is for maintenance treatment only, not for acute symptom relief 1
• Rinse your mouth after each use to reduce oral candidiasis risk 1
• Contact your healthcare provider if you develop white patches in your mouth or throat, worsening breathing, or decreased effectiveness of rescue medication 1