Enerzair® Breezhaler® is a triple therapy fixed dose combination inhaler containing an inhaled corticosteroid (ICS), an ultra-long-acting beta-agonist (LABA), and a long-acting muscarinic antagonist (LAMA), namely mometasone furoate, indacaterol and glycopyrronium. It is indicated for maintenance treatment of severe asthma in those who have inadequate control from using a combination of ICS and LABA. Studies show that the Enerzair® combination has demonstrated superiority to treatment with indacaterol and mometasone combination alone, in terms of change from the baseline forced expiratory volume in one second (FEV1) after 26 weeks of treatment and other measures of lung function.
The inhaler comes in two strengths: either indacaterol 114mcg, glycopyrronium 46mcg, mometasone furoate 68mcg or as indacaterol 114mcg, glycopyrronium 46mcg, mometasone furoate 136mcg (2). The dose is delivered using the Breezhaler® device, with inhalation of the content of one capsule once daily being the recommended dose. As with other Breezhaler® devices, the administration instructions are detailed below in Figure 1 below.
|Figure 1: Instructions for using Breezhaler® device (adapted from Asthma Australia)|
|*Wash hands before using inhaler device*
Other important points:
● Only use the capsules provided in the pack with the inhaler
● Keep capsules in the blister until you need them
● Peel the blister back to retrieve the capsule, don’t push the capsule through the blister
Mild side effects are common when using the Breezhaler® device and include changed voice, sore or dry mouth, sore throat, and muscle pain. As with other inhaler devices containing corticosteroids, the patient should be reminded to rinse their mouth with water, gargle and spit out after each use. An asthma action plan should also be developed so that the patient is aware of what steps to take and when a presentation to the emergency department is warranted. Inhaler technique should also be checked regularly by either the GP or pharmacist.
Enerzair® Breezhaler® is currently listed on the Pharmaceutical Benefits Scheme (PBS) under a streamlined authority, with the clinical criteria being patients who are 18 years of age or older and having had at least one severe asthma exacerbation in the last 12 months prior to having first commenced treatment for severe asthma which required systemic corticosteroid treatment despite each of i) receiving optimised asthma therapy, ii) being assessed for adherence to therapy, and iii) being assessed for correct inhaler technique. Optimised asthma therapy includes adherence to the maintenance combination of an ICS of at least 800mcg budesonide per day or equivalent, and a LABA.
- Asthma Australia. Enerzair Breezhaler [Internet]. Chatswood NSW Australia: Asthma Australia; 2021 [updated 2021 July 14; cited 2023 Feb 03].
- Australian Government Department of Health and Aged Care. The Pharmaceutical Benefits Scheme: Indacaterol + Glycopyrronium + Mometasone [Internet]. Australia: Australian Government Department of Health and Aged Care; 2021 [cited 2023 Feb 03].
- Australian Medicines Handbook [Internet]. Adelaide: AMH; 2022. Indacaterol with glycopyrronium and mometasone [cited 2023 Feb 03].
- Canadian Agency for Drugs and Technologies in Health. Clinical Review Report: Indacaterol Acetate- Glycopyrronium Bromide- Mometasone Furoate (Enerzair Breezhaler): (Novartis Pharmaceuticals Canada Inc.): Indication: Asthma maintenance, adults [Internet]. Ottowa Canada: CADTH; 2021 [cited 2023 Feb 3].
- National Asthma Council Australia. Asthma action plans [Internet]. South Melbourne Victoria Australia: National Asthma Council Australia; 2017 [cited 2023 Feb 03].
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