From the Guidelines
Pulmicort (budesonide) and Breztri (budesonide/glycopyrrolate/formoterol) should not be taken together daily as they both contain budesonide, which could lead to steroid overdose. Breztri is a triple-therapy inhaler containing an inhaled corticosteroid (budesonide), a long-acting muscarinic antagonist (glycopyrrolate), and a long-acting beta-agonist (formoterol) used for COPD maintenance. Pulmicort is a single-agent inhaled corticosteroid typically used for asthma. Taking both medications would duplicate the corticosteroid component, potentially increasing side effects like oral thrush, voice changes, and adrenal suppression without additional benefit. Some key points to consider when managing COPD include:
- The use of long-acting β-agonists (LABAs), inhaled corticosteroids (ICS), combined LABA/ICS, and long-acting antimuscarinic antagonists (LAMAs) to improve lung function and reduce the frequency of acute COPD exacerbations 1.
- The potential benefits of triple therapy, including improved lung function and health-related quality of life, although the evidence is still limited 1.
- The importance of proper inhaler technique to ensure the medicine reaches the lungs effectively. If you're currently prescribed both medications, consult your healthcare provider immediately to clarify which medication you should be using. Your provider may have intended for you to switch from one medication to the other rather than using both concurrently. It's also worth noting that recent guidelines, such as the 2023 Canadian Thoracic Society guideline, provide updated recommendations on pharmacotherapy in patients with stable COPD, including the use of novel therapies and combination treatments 1. However, the most recent and highest quality study, 1, does not provide specific guidance on the use of Pulmicort and Breztri together, but it does emphasize the importance of personalized treatment approaches and careful consideration of the potential benefits and risks of different medications.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Pulmicort and Breztri Daily
- Pulmicort is another name for budesonide, an inhaled corticosteroid (ICS) used in the treatment of chronic obstructive pulmonary disease (COPD) 2.
- Breztri is a fixed-dose combination of budesonide, glycopyrronium, and formoterol, used for the maintenance treatment of COPD 2.
- The combination of budesonide, glycopyrronium, and formoterol has been shown to reduce the rates of moderate/severe COPD exacerbations and improve lung function to a greater extent than budesonide/formoterol and/or glycopyrronium/formoterol 2.
Efficacy of Breztri
- Breztri has been compared to other triple combination therapies in COPD, including fluticasone furoate/umeclidinium/vilanterol and beclomethasone dipropionate/glycopyrronium/formoterol fumarate, and has been found to have comparable efficacy in reducing exacerbation rates and improving lung function, symptoms, and health-related quality of life 3, 4.
- Breztri has also been shown to have benefits on lung function, exacerbations, and health-related quality of life versus dual therapies in patients with COPD and phenotypic features of asthma 5.
- The benefits of Breztri have been observed across different blood eosinophil counts, including those with counts ≥100 cells/mm³ 6.
Safety and Tolerability
- Breztri has been found to have a comparable safety and tolerability profile to other triple combination therapies in COPD 2, 4.
- The most common adverse events associated with Breztri are similar to those of the individual components, and the tolerability profile is generally similar to that of the individual components 2.