Utibron Neohaler Approved for COPD

Two Different Bronchodilators in one inhaler – Utibron Neohaler –  approved for COPD

On October 29, 2015, the US Food and Drug Administration approved a new inhaler called Utibron Neohaler for treatment of those with COPD. It is a combination inhaler containing two active ingredients: indacaterol (a long-acting beta2 agonist [called a LABA]) and glycopyrrolate (a long-acting muscarinic antagonist [called a LAMA]). These two medications work in different ways to open the breathing tubes (airways) to make it easier for those with COPD to breathe. The medications are supplied in a capsule containing dry powder for inhalation using the Neohaler. It is approved for use twice a day 1 2 hours apart.

It is the third dual bronchodilator combination inhaler approved in the US. The other two medications are Anoro Ellipta (also a dry powder) and Stiolto Respimat ( a fine mist). Both of these medications are used once daily in the morning.

Studies show that two bronchodilator medications in a single inhaler are more effective in opening the breathing tubes (improving breathing tests) and relieving shortness of breath than one bronchodilator. It is expected that dual bronchodilators will be used more widely to relieve shortness of breath and improve health-related quality of life in those with COPD.

My comment: Many physicians have been treating those with COPD with a combination of different  inhaled medications for some time. In the past, this required two different inhalers and, as a result, two separate co-payments for the individual. There are now three different dual bronchodilators available  in a single inhaler (Anoro, Stiolto, and Utibron) that provide treatment options for the unmet needs of individuals with COPD. I encourage you to discuss this information with your health care provider.


Dear Dr. Mahler:

My pulmonary doctor has recommended that I try medicines in a nebulizer machine to help my breathing.  Over the past few years my primary doctor and his PA have prescribed every possible inhaler for my COPD, but none of them seem to work very well. His nurse has shown me how to use these different inhalers, but it is confusing.  I have used the machine once when I had to go to the emergency room for my breathing and the medicine helped me a lot. Please tell me more about use of a nebulizer.

Fran from Little Rock, AR

Dear Fran:

A nebulizer is a machine that mixes air or oxygen with a liquid bronchodilator medicine (called an aerosol) that is inhaled to dilate, or open, the breathing tubes (airways). Nebulized therapy is used widely when someone with asthma or COPD comes to the Emergency Department or is admitted to the hospital with a breathing problem. The picture shows one type of nebulizer.

One type of nebulizer

One type of nebulizer

If your doctor orders the nebulizer and medicines from a durable medical equipment (abbreviated DME) company, someone, usually a respiratory therapist, will deliver the nebulizer and medicines to your home and show you how to use the system. Both short-acting (last 4 hours) and long-acting (last 12 hours) bronchodilator medicines are available to relax the breathing tubes (airways) and allow you to breathe easier. The person who delivers the equipment and liquid medicines will write down a schedule of how often you should take the prescribed medicine. Depending on your condition, your doctor may also order a liquid corticosteroid medicine to use in the nebulizer machine twice a day. This is usually prescribed if you experience frequent chest infections that cause breathing difficulty and increased coughing (called an exacerbation).

Woman inhaling aerosol from nebulizer

Woman inhaling aerosol from nebulizer

Remember, you should breathe in and out normally from the mouthpiece of the system when inhaling the aerosol. The  person who delivers the machine to your home will also show you how to clean the system.

I suggest that you give this approach a try as it will likely help your breathing.


Donald A. Mahler, M.D.

Incruse Ellipta is Now Available

On April 30, 2014, the United States Food and Drug Administration approved umeclidinium (brand name: Incruse Ellipta) as a once-daily inhaled bronchodilator for treatment of those with COPD, including chronic bronchitis and emphysema. As of January 2015, this medication is available in US pharmacies.

Incruse Ellipta is a once-daily dry powder bronchodilator

Incruse Ellipta is a once-daily dry powder bronchodilator

Incruse Ellipta is in the class of bronchodilators called long-acting muscarinic antagonists (LAMA).  Other approved medications in this class are tiotropium (brand name: Spiriva HandiHaler and Respimat) and aclidinium (brand name: Tudorza Pressair). These medications open the airways and make it easier to breathe by blocking a receptor in the muscles that wrap around breathing tubes.

Picture of Spiriva Respimat mist bronchodilator

Spiriva Respimat is a once daily bronchodilator that delivers a mist


Tudorza Pressair is a twice daily dry powder bronchodilator

Tudorza Pressair is a twice daily dry powder bronchodilator


Information about the bronchodilator (called the package insert) states that Incruse Ellipta should be used with caution in those with narrow-angle glaucoma and with urinary retention due to enlargement of the prostate. The most common reported side effect in studies was nasopharyngitis (irritation of nose and throat). Also, you should not take this medication if you are using Spiriva or Tudorza as they are the same type of brocnhodilators.

As always, you should discuss any new medication with your doctor.

Spiriva Available in Respimat Device

Releases a slow moving mist

Tiotropium bromide (brand name: Spiriva) has been available as a once daily dry powder bronchodilator for over 10 years. On September 25, 2014, the United States Food and Drug Administration (FDA) approved Spiriva in a new device called the Respimat. It is once daily bronchodilator for treating patients with COPD. When inhaled deep into the lungs, this slow moving mist opens the breathing tubes (airways) to make it easier to breathe.

In January 2015, Spiriva Respimat became available in pharmacies in the United State as a prescription medication, while it has been available in Europe for some time. The Respimat is used to deliver two other inhaled bronchodilators – albuterol and ipratropium combination (brand name: Combivent) and olodaterol (brand name: Striverdi).

Picture of Spiriva Respimat mist bronchodilator

Spiriva Respimat is a once daily bronchodilator that delivers a mist

Spiriva inhaled from the HandiHaler and from the Respimat have the same overall effects on opening the airways and making it easier to breathe. The different devices provide choices for patients with COPD. According to Boehringer Ingelheim Pharmaceuticals, Inc., the most common side effects reported with Spiriva Respimat include sore throat, cough, dry mouth, and sinus infection.

If Spiriva Respimat is prescribed for you, make sure to review inhaling instructions with your health care provider or pharmacist. The dose is two inhalations once daily. You should inhale slow and steady and then hold your breath as long as possible (up to 10 seconds if you can). This medication should be used with caution if you have narrow-angle glaucoma or difficulty urinating.

You should always discuss any new medication or delivery system with your doctor.

Umeclidinium (Incruse Ellipta) approved for COPD

GOOD NEWS! Umeclidinium approved to treat COPD.

On April 30, 2014, The United States Food and Drug Administration (FDA) approved a new bronchodilator called umeclidinium (brand name is Incruse™ Ellipta™). This dry powder medication is approved for once-daily maintenance treatment for patients with COPD including both chronic bronchitis and emphysema.  The approved dose is 62.5 mcg.  The approval was based on study results in over 2,500 patients with COPD and follows approval of this medication in Canada and Europe.

This medication belongs to the class of bronchodilators called a long-acting muscarinic antagonist (LAMA) and is similar to the once daily tiotropium (brand name: Spiriva™ HandiHaler™) and twice daily aclidinium (brand name: Tudorza™ Pressair™). As these three LAMA medications are the same class, you should only use of these bronchodilators at a time.

GlaxoSmithKline, the pharmaceutical company that makes Incruse™ Ellipta™, reported that the most common side effects are nasopharyngitis, upper respiratory tract infection, cough, and joint pain. The company warned that the medication should not be used if you have narrow-angle glaucoma or have problems with urination. GlaxoSmithKline plans to launch the medication in the US toward the end of 2014.