Do you also have a chronic lung disease, which is what we medically call COPD (Chronic Obstructive Pulmonary Disease)? If so, your doctor may have given you an inhaler like this. This is actually a combination of three medications. Although it may seem a little complicated at first glance, the way it is used and the things you need to know about it are very simple. So let's talk about this clearly today, as if we were talking to a good friend.
What actually happens with this inhaler?
Simply put, this inhaler helps your lungs breathe easier. It contains three main medications: Budesonide , Glycopyrrolate , and Formoterol . Let's take a look at what each of these does.
- Budesonide: This is an inhaled steroid. It works by reducing swelling and inflammation in your airways. When this swelling goes down, your airways become slightly wider.
- Glycopyrrolate and Formoterol: Both of these medications are called bronchodilators. This means that they work by relaxing the muscles around the narrowed and constricted airways, widening them. It's like widening a narrowed tube.
Because these three medications work together, this inhaler can help you breathe easier throughout the day. That's why we call it a "controller inhaler." That means it's used to control symptoms, to maintain them throughout the day, not for a sudden emergency.
Very important: This inhaler should never be used for a sudden COPD flare-up. Your doctor may have given you a separate "rescue inhaler" to use in such cases.
Things you need to tell your doctor before taking this medicine
It is very important that your doctor is fully aware of your health condition before giving you this medicine. If you have any of the conditions below, be sure to tell your doctor about it.
| Your medical conditions |
|---|
| Bladder problems or difficulty urinating |
| Bone problems (e.g. osteoporosis) |
| Diabetes |
| Eye diseases (e.g. glaucoma, cataracts) or vision problems |
| Heart disease or high blood pressure |
| A history of heart rhythm irregularities |
| Immune system weaknesses or infections |
| Kidney disease |
| Prostate diseases |
| Thyroid disease |
| If you have had an unusual or allergic reaction to these medicines (budesonide, formoterol, glycopyrrolate), other medicines, foods or preservatives |
| If you are pregnant, trying to get pregnant, or breastfeeding |
How do you use this inhaler correctly?
To get the most out of this, it's essential to know exactly how to use it.
- Take it at the right time: Take it at the same time every day , as prescribed by your doctor. It is usually prescribed to be taken twice a day (morning and evening).
- Shake well: Shake the inhaler well before use.
- Rinse your mouth (most important): After you finish taking the medicine, take some water in your mouth and rinse your mouth thoroughly, and spit it out without swallowing it. This is very important. Because if the steroid medicine in this medicine gets stuck in your mouth, it can cause a fungal infection (thrush) that causes white patches in your mouth. Rinsing your mouth is to prevent that.
- Do not take more than the prescribed amount: Do not take more than the amount prescribed by your doctor (e.g., if two puffs per day, only two).
- Don't stop: Keep using it until your doctor tells you to stop. Don't stop suddenly, even if you feel better.
If you have any doubts about how to use your inhaler, don't be shy and ask your doctor again to make sure.
What if I use too much medicine by mistake?
If you think you have taken more than you think, immediately call the National Poisons Information Centre at the Colombo National Hospital . Or go to the Emergency Treatment Unit (ETU) of the nearest hospital.
Other medications that may interact with this medicine
Not all medications you take are compatible with this inhaler. Some medications may increase side effects or change how well this medication works when taken with this inhaler.
| Medications that should never be taken with this inhaler |
|---|
| Medicines like Cisapride, Dronedarone, Pimozide, Thioridazine |
| MAOIs are medications used to treat mental illness. |
| This and other inhalers containing long-acting bronchodilators (LABAs) |
In addition, many other medications can interact with this. For example:
- Some medications for heart disease and high blood pressure (e.g., beta-blockers like Atenolol and Metoprolol)
- Some medications for conditions like depression
- Medicines like Ketoconazole and Itraconazole, which are used to treat fungal infections
- Some antiviral drugs for HIV or Hepatitis
- Medicines like Oxybutynin and Tolterodine, which are used for bladder problems
- Diuretics (medicines that remove water from the body)
- Other steroid pills (e.g. Prednisolone)
This list is not complete. Therefore, give your doctor a complete list of all medications, vitamins, herbal remedies, and supplements you take. Be sure to tell your doctor if you smoke or drink alcohol.
What are the expected side effects?
Like any medicine, this one can cause side effects in some people. Some are serious, some are common. It's important to be aware of these.
| Side effect | Description |
|---|---|
| Serious side effects that should be reported to your doctor immediately | |
| Allergic reactions | Skin rash, itching, swelling of the face, lips, tongue, difficulty breathing or swallowing. |
| Wheezing immediately after using the inhaler | If breathing difficulty increases immediately after taking the medicine. |
| Changes in heart rate | Heart palpitations, irregular heartbeat, chest pain, dizziness. |
| Eye problems | Sudden eye pain, blurred vision, and halos around lights. |
| Fungal infections of the mouth (Thrush) | White spots inside the mouth or on the tongue. |
| Difficulty urinating | Feeling difficulty or pain when urinating. |
| Side effects that are usually not serious, but should be reported to the doctor if they persist | |
| Sore throat, hoarseness | Hoarseness, Sore throat |
| Headache, cough, dry mouth | Headache, Cough, Dry mouth |
| Insomnia, body tremors | Trouble sleeping, Tremors |
How do you store and dispose of the medicine?
- Storage: Store this inhaler at room temperature (between 15-30 Celsius), in a dry place. Keep out of reach of children and pets. Never store near excessive heat or flame. The canister may explode. Do not refrigerate.
- Expiration: You should use the inhaler within 3 months (for the 120 puff canister) or 3 weeks (for the 28 puff canister) from the day you open the aluminum packet. Otherwise, discard the inhaler when the dose indicator shows zero (0) .
- Disposal: Consult your doctor on how to safely dispose of your used or expired inhaler.
Take-Home Message
- This inhaler is a "controller inhaler" that you take daily to control your asthma. Do not use it for sudden shortness of breath. Use your "rescue inhaler" for that.
- After each use, rinse your mouth thoroughly with water and spit it out without swallowing. This is essential to prevent fungal infections in the mouth.
- Inform your doctor about all other medications, vitamins, and traditional medicines you are taking.
- If your symptoms worsen or you find yourself having to use your "reliever inhaler" more often, call your doctor right away.
- Store the inhaler correctly and dispose of it safely once it has expired.
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