From 1 November 2021, another triple therapy inhaler was added to the Pharmaceutical Benefits Scheme (PBS). Breztri Aerosphere® (budesonide + formoterol + glycopyrronium) contains an inhaled corticosteroid (ICS), a long-acting β2-agonist (LABA), and a long-acting muscarinic antagonist (LAMA). This streamlined authority listing is for chronic obstructive pulmonary disease (COPD) in patients who have experienced at least one severe or multiple moderate exacerbations in the previous 12 months. Patients must also have been stabilised on a combination of a LAMA, LABA, and ICS.

The ETHOS trial compared Breztri® triple therapy (160mcg or 320mcg twice daily of budesonide) with dual therapy of glycopyrronium + formoterol and budesonide + formoterol. Patients in the triple therapy group experienced significantly fewer moderate or severe exacerbations compared to the dual therapy groups. This study also demonstrated greater efficacy of lower-dose corticosteroids in triple-therapy compared to higher dose corticosteroids used in dual therapy.

Breztri Aerosphere® utilises a novel formulation technology. This allows the delivery of a stable and homogenous suspension that dissolves once it reaches the airways. Studies suggest that the Aerosphere® may provide benefits over traditional pressurised metered-dose inhalers (pMDI) in regard to optimal particle size and the consistent and effective delivery of medication to peripheral and central airways. The Aerosphere® is used in much the same way as a regular pMDI.


  1. Breztri Aerosphere® (budesonide/glycopyrronium/formoterol (eformoterol) fumarate dihydrate) Australian approved product information. Macquarie Park: AstraZeneca. Approved July 2021.
  2. Rabe KF, Martinez FJ, Ferguson GT, Wang C, Singh D, Wedzicha JA, et al. Triple inhaled therapy at two glucocorticoid doses in moderate-to-very-severe COPD. N Engl J Med. 2020; 383: 35-48.
  3. Usmani OS, Roche N, Jenkins M, Stjepanovic N, Mack P, De Backer W. Consistent pulmonary drug delivery with whole lung deposition using the Aerosphere inhaler: a review of the evidence. Int J Chron Obstruct Puml Dis. 2021; 16: 113-24.

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