Take a deep breath. It is the NAPLEX Question of the Week!

Today's question focuses on inhaler technique.

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EP is a 52 year old female that comes into your community pharmacy to pick up new prescriptions for Breo Ellipta and Ventolin HFA. She states she was just recently diagnosed with COPD and has never used either of these inhalers before. Which of the following are counseling points you would want to make sure you tell EP about her Breo Ellipta? Select all that apply. 

 

A. Breo Ellipta is meant to be used at the same time every day  

B. Discard the device 4 weeks after it is removed from the foil tray or when the dose counter reads “0” 

C. Exhale fully before taking one quick and deep breath through the mouthpiece

D. After inhaling medication, hold breath for 3 to 4 seconds and then exhale slowly and gently 

E. Patients should rinse their mouth after using this medication 

 

Answers with rationale:

The correct answers are A, D, and E.

Breo Ellipta is a breath activated aerosol powder device that contains two inhaled medications: fluticasone furoate, an inhaled corticosteroid (ICS), and vilanterol, a long-acting beta-2 agonist (LABA). It comes in two strengths (100/25 mcg and 200/25 mcg). While it is FDA approved for the treatment of both asthma and COPD, the maximum dose for COPD is 1 inhalation of the BreoEllipta 100/25 mcg once daily. 

Since Breo Ellipta contains an ICS and a LABA, it is meant to be used at the same time every day as a maintenance inhaler to prevent exacerbations, making answer A correct. Patients who are given a maintenance inhaler should also be prescribed a rescue inhaler such as Ventolin HFA (albuterol sulfate) as a PRN medication to be used when experiencing shortness of breath or wheezing. Patients should be counseled on the difference between their maintenance inhaler and their rescue inhaler to ensure proper treatment and decrease COPD exacerbations. 

Breo Ellipta comes in a foil pack inside of a box. Inhaler devices dispensed in the community setting contain 30 doses for inhalation (or 14 doses for the institutional packs). Each device should be discarded after 6 weeks or when the dose counter reads “0”, making answer B incorrect

Patients using Breo Ellipta should be instructed to take one long, steady and deep breath in when using this device, making answer C incorrect

An important counseling point with any inhaler is for the patient to hold their breath for a specific amount of time. For Breo Ellipta, patients should be instructed to hold their breath for 3-4 seconds after inhalation and then exhale slowly and gently, making Answer D correct

Lastly, inhaled corticosteroids have a common adverse event of oral candidiasis or thrush. One way to help prevent this adverse effect from occurring is for the patient to rinse their mouth after each use of an ICS. Since Breo Ellipta contains fluticasone furoate, an ICS, patients with this inhaler should be instructed to rinse their mouth after using this inhaler, making Answer E correct. 

Many inhalers are combination therapies and come in a variety of inhalation devices. These are important to review before taking the NAPLEX as they often have different counseling points regarding the device and the medications included. Additionally, since inhalers are multi-use devices, knowing beyond use dates and explaining these to patients for each device is an important aspect of appropriate patient counseling. 

Next week we celebrate the 100th edition of the Question of the Week. If you have benefited from these questions each week, please spread the word and share!

Dr. B

Christopher M. Bland

Clinical Associate Professor, University of Georgia College of Pharmacy

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