Nebulized Nebulized Bronchodilator (Brovana) is Safe and Effective

Study shows Safety and Benefits of Nebulized Bronchodilator (Brovana)

In the December 2014 issue of CHEST (volume 146; pages 1531-1542), Donohue and coauthors report that arformoterol (brand name: Brovana) used to treat patients with COPD showed a 40% lower risk of dying of failure of the lungs OR need to be hospitalized for worsening of their COPD (called an exacerbation) than those taking a placebo treatment.

Here is the reason for this study: The United States Food and Drug Administration (FDA) has required that all pharmaceutical companies that make certain types of inhaled bronchodilators called long-acting beta-agonists (abbreviated LABAs) perform long-term studies to ensure safety. In response to the FDA, Sunovion Pharmaceuticals Company sponsored a study of 841 patients evaluating nebulized bronchodilator: one-half inhaled arformoterol solution from a nebulizer twice a day, and the other half inhaled salt water from a nebulizer twice a day for one year. All subjects were able to take their other regular COPD medications.

Man inhaling medication from a nebulizer

Man inhaling medication from a nebulizer

The key findings were that:
1. more patients who received placebo (salt water) decided to stop being in the study
2. fewer patients receiving arformotrol were hospitalized for worsening of their COPD (an exacerbation)
3. lung function (breathing tests) and quality of life were better in those who received arformoterol than placebo

In summary, these findings are reassuring about the safety and benefits of arformoterol, a bronchodilator solution used in a nebulizer twice a day.

My Comment: Most patients with COPD use dry powder or aerosol (water droplets) medications that are inhaled from different devices. However, nebulized bronchodilator medications are available as an option. In my practice, I consider nebulized medications as treatment when someone with COPD:
1. is unable to use standard inhalers because of a physical problem, such as arthritis or a stroke
2. has difficulty coordinating breathing and breath holding
3. finds that it is not “easier to breathe” despite using correct technique with the inhaler
4. has a low peak inspiratory flow rate (PIFR). This means that the person does not have enough force to inhale the dry powder out of the device. Your PIFR can be measured in the doctor’s office or in a pulmonary function laboratory.

If any of these conditions fit your situation, you should discuss nebulized therapy with you doctor.

Donald A. Mahler, M.D.

New Drug Available for COPD

New Drug – Striverdi Respimat – is now available as treatment for COPD.

On July 31, 2014, the United States Food and Drug Administration approved olodaterol (brand name: Striverdi Respimat) for the once daily treatment of COPD. Olodaterol is a long-acting beta-agonist (appreviated: LABA) bronchodilator that relaxes the muscle that wraps around breathing tubes (airways) to make it easier to breathe.

In October 2014, Striverdi Respimat became available for use in the United State as a prescription medication.

Striverdi Respimat releases a fine mist that relaxes muscles wrapped around breathing tubes.

Striverdi Respimat releases a fine mist when inhaled.

With the Respimat device, a slow and steady inhalation is recommended in order to inhale the fine mist deep into the lower parts of your lungs. You should then hold your breath as long as possible

Striverdi Respimat is the similar to another once daily LABA bronchodilator called indacaterol (brand name: Arcapta Neohaler).

Arcapta Neohaler is a once daily dry powder bronchodilator

Arcapta Neohaler is a once daily dry powder bronchodilator

With the Neohaler device, a hard and fast inhalation is recommended in order to inhale the dry powder medication deep into the lower parts of your lungs. You should then hold your breath as long as possible.

Because Striverdi Respimat and Arcapta Neohaler are the same class of bronchodilator (called LABA), you should only use one of these medications each day. Both Striverdi Respirmat and Arcapta Neohaler can be used with the other class of bronchodilator called a long-acting muscarinic antagonist (abbreviated: LAMA). LAMA medications include
ipratropium (Atrovent), aclidinium (Tudorza), tiotropium (Spriva), and umeclidinium (Incruse). Studies show that use of both LABA and LAMA bronchodilators together are more effective than use of one of these medications alone.

Neither Striverdi Respimat nor Arcapta Neohaler is approved for use in those with asthma. Also, these medications are not to be used if you experienced sudden breathing difficulty. If that occurs, you should use your albuterol either in an inhaler or with a nebulizer.