There are many different inhaler medications and devices available for the treatment of chronic obstructive pulmonary disease (COPD). Can you identify them by name? To find out, match each brand name in Section I with its generic name in Section II.
Section I
______ 1. Combivent Respimat (Boehringer Ingelheim Pharmaceuticals, Inc.)
______ 2. Trelegy Ellipta (GlaxoSmithKline)
______ 3. Symbicort (AstraZeneca)
Section II
a. Fluticasone furoate/umeclidinium/vilanterol. This triple-combination inhaler contains an inhaled corticosteroid (ICS), fluticasone furoate; a long-acting muscarinic antagonist, umeclidinium; and a long-acting beta2-adrenergic agonist (LABA), vilanterol. It is indicated for maintenance treatment of both asthma (in patients age 18 years and older) and COPD.1 It results in bronchodilation and prevents and reduces airway inflammation. For the treatment of COPD, it is administered once daily by oral inhalation. When using the dry powder inhaler, patients should be instructed to slide the cover off, exhale fully away from the device, put the mouthpiece in their mouth and close their lips to form a good seal, inhale steadily and deeply through their mouth, remove the inhaler from their mouth and hold their breath for 3 to 4 seconds or as long as is comfortable, exhale gently and away from the inhaler after administering the dose, and close the inhaler after use.1 As this inhaler contains an ICS, remind patients to rinse their mouth with water and expectorate after use to avoid thrush.
b. Ipratropium/albuterol. This combination of a short-acting muscarinic antagonist and a short-acting beta2-agonist inhaler is indicated for patients with COPD on a regular aerosol bronchodilator, but with evidence of continued bronchospasm requiring a second bronchodilator.2 As bronchodilators, these medications work to relax airway muscles. This inhaler device uses a soft mist to deliver the medication, usually indicated at a dose of one inhalation four times per day. The cartridge must be inserted into the inhaler device and primed when used for the first time. Patients should also record the "discard by" date on the label (3 months after first use or cartridge insertion).2 For daily use, patients should remember the acronym TOP: Turn, Open, and Press. Patients should be instructed to Turn the clear base in the direction of the arrows until it clicks, Open the cap until it snaps fully open, exhale slowly, close the lips around the mouthpiece, and finally Press the dose-release button while taking a slow, deep breath through the mouth. When using this inhaler device, patients should be instructed to hold their breath for as long as they are comfortable, up to 10 seconds.
c. Budesonide/formoterol. This combination ICS/LABA is available as a hydrofluoroalkane-propelled metered-dose inhaler, indicated for both asthma and COPD. For the treatment of COPD, the usual dosing is two inhalations twice daily. This device contains an ICS (budesonide) and LABA (formoterol), which work to relax airway muscles and reduce airway inflammation.3 To use this inhaler device, patients should be educated to prime the inhaler before first use: shake the inhaler for 5 seconds, release a test spray away from their face, and again, shake the inhaler for 5 seconds and release a second test spray in the same way. Priming should be performed if the device isn't used in 7 days or if it is dropped. If used routinely, patients must shake the inhaler for 5 seconds, remove the mouthpiece cover, exhale fully, place the mouthpiece in their mouth and close the lips around it, inhale slowly from the mouth while depressing the top of the counter on the inhaler device, and hold their breath for 10 seconds.3 As this device contains an ICS, instruct patients to rinse their mouths and expectorate after use.
Answers: 1. B, 2. A, 3. C
REFERENCES