Inhaled drugs for COPD: formulation and device summary
A summary of inhaled drugs available in Australia for COPD at the time of writing is provided in Inhalers available in Australia for COPD. For detailed information about delivery devices, including links to videos and patient handouts, see Inhalational drug delivery devices.
|
Drug or drug combination (brand examples) |
Delivery device [NB1] (brand examples) |
Dose per inhalation |
Usual regimen for COPD |
|---|---|---|---|
|
SABA inhalers | |||
|
salbutamol (Ventolin, Asmol, Airomir) |
pMDI or breath-activated pMDI (Autohaler) |
100 micrograms |
1 to 2 inhalations as required |
|
terbutaline (Bricanyl) |
multiple-dose DPI (Turbuhaler) |
500 micrograms |
1 inhalation as required |
|
SAMA inhaler [NB2] | |||
|
ipratropium (Atrovent) |
pMDI |
21 micrograms |
2 inhalations as required |
|
LAMA inhalers | |||
|
aclidinium (Bretaris) |
multiple-dose DPI (Genuair) |
322 micrograms |
1 inhalation twice daily |
|
glycopyrronium (Seebri) |
single-dose DPI (Breezehaler) |
50 micrograms |
1 inhalation daily |
|
tiotropium (Spiriva, Braltus) |
single-dose DPI (Handihaler) |
18 micrograms [NB3] |
1 inhalation daily |
|
single-dose DPI (Zonda device) |
13 micrograms [NB3] |
1 inhalation daily | |
|
mist inhaler (Respimat) |
2.5 micrograms |
2 inhalations daily | |
|
umeclidinium (Incruse) |
multiple-dose DPI (Ellipta) |
62.5 micrograms |
1 inhalation daily |
|
LABA inhalers [NB4] | |||
|
indacaterol (Onbrez) |
single-dose DPI (Breezehaler) |
150 micrograms |
1 to 2 inhalations daily |
|
single-dose DPI (Breezehaler) |
300 micrograms |
1 inhalation daily | |
|
LABA+LAMA fixed-dose combination inhalers | |||
|
formoterol+aclidinium (Brimica) |
multiple-dose DPI (Genuair) |
12+340 micrograms |
1 inhalation twice daily |
|
indacaterol+glycopyrronium (Ultibro) |
single-dose DPI (Breezehaler) |
110+50 micrograms |
1 inhalation once daily |
|
olodaterol+tiotropium (Spiolto) |
mist inhaler (Respimat) |
2.5+2.5 micrograms |
2 inhalations once daily |
|
vilanterol+umeclidinium (Anoro) |
multiple-dose DPI (Ellipta) |
25+62.5 micrograms |
1 inhalation once daily |
|
ICS+LABA fixed-dose combination inhalers | |||
|
budesonide+formoterol (Symbicort, DuoResp) |
pMDI (Rapihaler) |
200+6 micrograms |
2 inhalations twice daily |
|
multiple-dose DPI (Turbuhaler, Spiromax) |
400+12 micrograms |
1 inhalation twice daily | |
|
fluticasone furoate+vilanterol (Breo) |
multiple-dose DPI (Ellipta) |
100+25 micrograms [NB5] |
1 inhalation once daily |
|
fluticasone propionate+salmeterol (Seretide, SalplusF, Cipla, Pavtide) |
pMDI |
250+25 micrograms |
2 inhalations twice daily |
|
multiple-dose DPI (Accuhaler) |
500+50 micrograms |
1 inhalation twice daily | |
|
ICS+LAMA+LABA fixed-dose combination inhaler | |||
beclometasone+glycopyrronium+formoterol (Trimbow) |
pMDI |
100+10+6 micrograms | 2 inahalations twice daily |
budesonide+ glycopyrronium+formoterol (Breztri) | pMDI | 160+7.2+5 micrograms | 2 inhalations twice daily |
fluticasone furoate+umeclidinium+vilanterol (Trelegy) | multiple-dose DPI (Ellipta) | 100+62.5+25 micrograms | 1 inhalation once daily |
Note:
COPD = chronic obstructive pulmonary disease; DPI = dry powder inhaler; ICS = inhaled corticosteroid; LABA = long-acting beta2 agonist; LAMA = long-acting muscarinic antagonist; SABA = short-acting beta2 agonist; SAMA = short-acting muscarinic antagonist; PBS = Pharmaceutical Benefits Scheme; pMDI = pressurised metered dose inhaler NB1: For detailed information about delivery devices, including links to videos and patient handouts, see Inhalational drug delivery devices. NB2: Ipratropium is not usually used for symptom relief in COPD—it is contraindicated in patients taking a LAMA, is more expensive than a SABA, and may increase the risk of cardiovascular events. NB3: Tiotropium dry powder inhaler is available as a 13 microgram inhaler and an 18 microgram inhaler. These inhalers are bioequivalent, both delivering 10 micrograms per dose, and can be used interchangeably. NB4: Indacaterol is the only LABA available on the PBS as monotherapy for COPD. See the PBS website for current information. NB5: Fluticasone furoate+vilanterol is also available in a 200+25 microgram formulation, but this higher dose increases the risk of adverse effects (including pneumonia), and does not improve COPD outcomes. | |||