kar asked
I have had reactions to 2 inhalers Incruse and Stiolto. After 4-6 weeks of using I get an upper respiratory infection or sore throat. My pulmonary doctor says that all inhalers have the same active ingredients so there is nothing else to try. Do you agree?
At a glance
- Stiolto contains two active ingredients, tiotropium, a long-acting anticholinergic and olodaterol, a long-acting beta-2 agonist.
- COPD drugs that contain corticosteroids are generally reserved for those with severe symptoms or who also have asthma symptoms since they can increase the risk of pneumonia.
Answer
There are a number of different inhalers available to treat COPD (chronic obstructive pulmonary disease) and comparing them can be a confusing business.
As your doctor referenced, many of them share active ingredients but they don't all have the same ones.
COPD Drug Classes
To start off, there are, in general, three different classes of drugs that are used to treat COPD:
- Inhaled corticosteroids
- Anticholinergics (i.e. antimuscarinics)
- Long-acting beta-2 agonists
There are several drugs in each class, which is why it's so easy to get bogged down in the sheer number of drug names and active ingredients.
Let's first take a look at the two you had allergic reactions to and go from there. I will list possible alternatives in the following sections for you to talk to your pulmonologist about.
Incruse Active Ingredients
Incruse Ellipta contains one active ingredient, umeclidinium.
Umeclidinium is classified as a long-acting anticholinergic, a class of drugs that are often referred to as long-acting muscarinic antagonists (LAMA).
LAMA drugs, according to COPD treatment guidelines, can be used alone (i.e. monotherapy) for COPD patients, depending on the severity of the disease. They are very often used in combination however with the other two classes of drugs stated above (corticosteroids, long-acting beta agonists).[1]
LAMA drugs work by causing bronchodilation (i.e. opening the airways) and can also help to dry mucus secretions.
Other Anticholinergic; Long-Acting Beta-2 Agonist Options
Since you have only been on an anticholinergic or long-acting beta-2 agonist (or both), I won't list alternative options that contain the third class of COPD drugs I mentioned (corticosteroids). I touch on that briefly in the next section.
In terms of alternative options for you, there are many drugs that contain different active ingredients than what you have used.
Since there are so many, I will simply list them in 3 categories:
- Long-Acting Beta-2 Agonists (LABAs)
- Long-Acting Muscarinic Antagonists (LAMAs)
- Combination LABA; LAMA
Long-Acting Beta-2 Agonists (LABAs) For COPD
Long-acting beta-2 adrenergic agonists (LABA) come in a variety of dosage forms (e.g. nebulizer solution, dry powder inhaler) and are used once to twice daily for most individuals.
- Brovana (Arformoterol) (only comes as a nebulizer solution and is used twice a day)
- Perforomist (Formoterol) (only comes as a nebulizer solution and is used twice a day)
- Arcapta (Indacaterol) (used once daily)
- Striverdi Respimat (Olodaterol) (used once daily)
- Serevent Diskus (Salmeterol) (used twice daily)
Long-Acting Muscarinic Antagonists (LAMAs)
beta-2 adrenergic agonists (LABA) are used once to twice daily for most individuals and come in many dosage forms.
- Tudorza Pressair (Aclidinium) (used twice daily)
- Seebri Neohaler (Glycopyrrolate) (used twice daily)
- Yupelri (Revefenacin) (only comes as a nebulizer solution) (used once daily)
- Spiriva HandiHaler; Spiriva Respimat (Tiotropium) (used once daily)
- Incruse Ellipta (Umeclidinium) (used once daily)
Combination LABA/LAMA
- Bevespi Aerosphere (Formoterol/Glycopyrrolate)
- Utibron Neohaler (Indacaterol/Glycopyrrolate)
- Stiolto Respimat (Olodaterol/Tiotropium)
- Anoro Ellipta (Vilanterol/Umeclidinium)
If your doctor wants to try you on a combination LABA/LAMA that contains ingredients you have not been on, Bevespi and Utibron may be options.
It also may be worth seeing if you can pinpoint your allergy to a specific ingredient. Is it just olodaterol or umeclidinium? Finding this out will open up for options for you.
Final Words
As you can see from the above information, there are a number of potential drug options for you if you happen to be allergic or sensitive to a particular ingredient.
Although many drugs share active ingredients, you should be able to find one, or a combination of them, that work for you and is well tolerated. Be sure to discuss your options with your doctor.
References
- ^ COPD Guidelines: A Review of the 2018 GOLD Report.tis. PubMed
- ^ Long-acting β2-agonists (LABA) in chronic obstructive pulmonary disease: efficacy and safety. PubMed
- ^ Global Initiative for chronic obstructive lung disease. A Guide for Health Care Professionals
- ^ Pneumonia Complicating COPD: Are Corticosteroids a Help or a Hindrance? PubMed
- Brovana Prescribing Information
- Perforomist Prescribing Information
- Striverdi Prescribing Information
- Arcapta Prescribing Information
- Tudorza Prescribing Information
- Seebri Prescribing Information
- Yupelri Prescribing Information
- Spriva Manufacturer Website
- Incruse Manufacturer Website
