budesonide + formoterol + glycopyrronium: clinical use

Prescribing considerations

• Confirm that the patient meets the licensed COPD indication and is not using the inhaler as rescue therapy.
• Review inhaler technique, adherence and coordination; consider a compatible spacer where appropriate.
• Use caution with significant cardiovascular disease, QT prolongation, thyrotoxicosis, diabetes, narrow-angle glaucoma, urinary retention or symptomatic prostatic enlargement.
• In severe renal or hepatic impairment, use only where expected benefit outweighs risk.
• Remain alert to pneumonia, particularly where additional risk factors are present.
• Consider cumulative systemic corticosteroid exposure, adrenal suppression, bone health and ocular effects.

Contraindications and cautions

• Hypersensitivity to budesonide, formoterol, glycopyrronium or any excipient.

Monitoring

• COPD symptoms, exacerbations, reliever use and inhaler technique.
• Features of pneumonia or paradoxical bronchospasm.
• Blood glucose in patients with diabetes.
• Potassium where clinically indicated, especially with hypoxia or potassium-lowering treatments.
• Cardiovascular symptoms and rhythm in susceptible patients.
• Urinary retention, acute narrow-angle glaucoma symptoms and visual disturbance.
• Systemic corticosteroid effects where exposure is prolonged or cumulative.

Clinical pharmacology

Budesonide provides local glucocorticoid anti-inflammatory activity. Formoterol is a selective long-acting beta2 agonist. Glycopyrronium is a competitive, reversible long-acting muscarinic antagonist acting principally at airway M3 receptors.

Formulation and product differences

• The selected product is a pressurised inhalation suspension with a dose indicator.
• It requires shaking and product-specific priming.
• It can be used with compatible spacer devices, including AeroChamber Plus Flow-Vu.
• The canister, actuator and mouthpiece are product-specific and should not be interchanged with another inhaler.

Inhaled preparation

Route: Inhaled

Strengths: 5 micrograms + 7.2 micrograms + 160 micrograms