How Do Respiratory Inhalant Combos Work?

Respiratory inhalant combos are medications prescribed to treat respiratory conditions such as chronic obstructive pulmonary disease (COPD) and asthma. Respiratory inhalant combos are combinations of different classes of medications that work in unique ways to dilate the bronchial passage and ease breathing.

Respiratory inhalant combos work in the following ways:

• Relax bronchial smooth muscles
• Inhibit hypersensitive reactions in the bronchial passage
• Reduce mucus secretion in the respiratory system
• Improve lung function

Respiratory inhalant combos are different combination formulations of the following classes of medications:

• Long-acting beta2 agonists (LABAs): LABAs enhance the activity of beta-2 adrenergic receptors, protein molecules on cell surfaces that are stimulated by epinephrine, a natural hormone in the body. LABAs relax bronchial muscles and inhibit hypersensitivity reactions from mast cells, a type of immune cells that initiate allergic reactions.
• Long-acting muscarinic antagonists (LAMA): LAMAs block the activity of muscarinic receptors which make muscles contract in response to acetylcholine, a chemical that nerve endings secrete. LAMAs relax bronchial smooth muscles, reduce mucus secretion in the respiratory system and improve lung function.
• Corticosteroids: Corticosteroids are potent anti-inflammatory agents that prevent immune cells from releasing pro-inflammatory substances. Corticosteroids affect many types of immune cells such as mast cells, eosinophils, basophils, lymphocytes, macrophages, and neutrophils.

Respiratory inhalant combos are administered as oral inhalations in the form of powders, sprays, aerosolized tiny particles or droplets, or solutions nebulized into a fine mist. Many types of inhalation devices such as metered dose inhalers and nebulizers may be used.

Respiratory inhalant combos are used for the treatment of the following conditions:

FDA-approved:

• Long term maintenance treatment of chronic obstructive pulmonary diseases including:
  • Chronic bronchitis
  • Emphysema
• COPD is not adequately controlled with a single bronchodilator
• COPD exacerbations
• Prevention and maintenance treatment of asthma, an inflammatory bronchial condition
• Asthma is not adequately controlled with long-term medications

Orphan designation:

• Treatment of symptomatic exophthalmos (bulging of eyes) associated with thyroid-related eye disease

Side effects of respiratory inhalant combos may include the following:

• Upper respiratory tract infection
• Headache
• Nasopharyngitis (inflammation of nose and throat)
• Pharyngitis (throat inflammation)
• Bronchitis (inflammation of bronchial passage)
• Sinusitis (inflammation of the sinuses)
• Rhinitis (inflammation of the nasal passage)
• Cough
• Oropharyngeal candidiasis (Candida infection in mouth and throat)
• Oropharyngeal pain
• Oropharyngeal edema
• Facial edema
• Upper respiratory inflammation
• Dryness of throat
• Throat irritation
• Dysphonia (hoarseness)
• Nasal congestion
• Epistaxis (nasal bleeding)
• Lung disease
• Respiratory congestion and tightness
• Dyspnea (shortness of breath)
• Exacerbation of asthma/COPD symptoms
• Immediate and paradoxical bronchospasm
• Wheezing
• Pneumonia
• Viral respiratory infections
• Tracheitis (bacterial infection of the trachea)
• Candidiasis, nonspecific site
• Oral candidiasis
• Xerostomia (dry mouth)
• Mucosal ulcers
• Tooth abscess
• Gingivitis (gum inflammation)
• Glossitis (tongue inflammation)
• Stomatitis (oral inflammation)
• Dysgeusia (taste disorder)
• Dysphagia (swallowing difficulties)
• Nausea
• Vomiting
• Diarrhea
• Dyspepsia (indigestion)
• Heartburn
• Gastrointestinal (GI) discomfort or pain
• Viral GI infections
• Gastroenteritis
• Gastroesophageal reflux disease (GERD)
• Constipation
• Intestinal obstruction including paralytic ileus (paralysis of the intestinal smooth muscles)
• Urinary tract infection
• Dysuria (painful urination)
• Urinary retention
• Dehydration
• Influenza
• Fever
• Generalized pain
• Back pain
• Muscle spasms or cramps
• Muscle weakness
• Musculoskeletal pain
• Myositis (muscle inflammation)
• Arthralgia (joint pain)
• Joint swelling
• Osteoporosis (bone loss)
• Pain in extremities
• Leg cramps
• Fatigue
• Malaise
• Asthenia (weakness)
• Drowsiness
• Dizziness
• Fall
• Contusion
• Sleep disturbance
• Insomnia
• Anxiety
• Depression
• Agitation
• Aggression
• Nervousness
• Abnormal behavior
• Behavioral changes such as hyperactivity and irritability primarily in children (rare)
• Central nervous system stimulation
• Coordination difficulty
• Restlessness
• Paresthesia (abnormal sensation in the skin)
• Tremor
• Chest pain and discomfort
• Angina pectoris (chest pain due to coronary heart disease)
• Hypertension (high blood pressure)
• Hypotension (low blood pressure)
• Increased systolic BP
• Decreased diastolic BP
• Palpitations
• Cardiac arrhythmias (irregular heart rhythms) such as:
  • Ventricular tachycardia (rapid heart rate beginning in the ventricles)
  • Supraventricular tachycardia (rapid heart rate beginning above the ventricles)
  • Ventricular and supraventricular extrasystoles (extra heartbeats)
  • Ventricular tachyarrhythmia (rapid and irregular heartbeat in the ventricles)
  • Atrial fibrillation (irregular and rapid heart rate with the atria out of synchronization with the ventricles)
  • QT prolongation (abnormal ECG reading)
• Myocardial infarction (heart attack)
• Increase in blood creatinine phosphokinase (CPK)
• Hypokalemia (low potassium level in the blood)
• Hyperglycemia (high blood glucose levels)
• Weight gain
• Glaucoma (an eye condition that damages the optic nerve)
• Precipitation of worsening of narrow-angle glaucoma
• Cataracts
• Blurred vision
• Increase in intraocular pressure
• Mydriasis (dilation of pupils)
• Acute eye pain
• Halo vision
• Eye irritation
• Accommodation disorder (eye focusing difficulty)
• Corneal edema
• Conjunctival hyperemia (dilation and redness of blood vessels in the conjunctiva, the membrane on the whites of the eyes, and the inner surface of eyelids)
• Conjunctivitis (inflammation of the conjunctiva)
• Central serous chorioretinopathy (fluid buildup under the retina which can lead to retinal detachment and vision loss)
• Hypersensitivity reactions such as:
  • Rash
  • Urticaria (hives)
  • Pruritus (itching)
  • Dry skin
  • Skin infection
  • Skin ulcer
  • Dermatitis
  • Photodermatitis (light-sensitive dermatitis)
  • Angioedema (swelling in the tissue under the skin or mucous membranes)
  • Laryngospasm (spasm of vocal cords)
  • Anaphylaxis (severe allergic reaction)
• Ecchymosis (bruising)
• Edema
• Flushing
• Pallor
• Alopecia (hair loss)
• Hyperhidrosis (excessive sweating)
• Metabolic acidosis (increased blood acidity) with albuterol combos
• Cushing syndrome/hyperadrenocorticism (a condition caused by high cortisol levels from prolonged corticosteroid use)
• Cushingoid features (facial roundness and fat accumulation in midsection and upper back due to Cushing syndrome)
• Growth velocity reduction in children and adolescents
• Dysmenorrhea (painful menstruation)

Information contained herein is not intended to cover all possible side effects, precautions, warnings, drug interactions, allergic reactions, or adverse effects. Check with your doctor or pharmacist to make sure these drugs do not cause any harm when you take them along with other medicines. Never stop taking your medication and never change your dose or frequency without consulting your doctor.

Generic and brand names of respiratory inhalant combo drugs include:

• Advair Diskus
• aclidinium/formoterol inhaled
• Advair Diskus
• Advair HFA
• AirDuo Digihaler
• AirDuo RespiClick
• albuterol/ipratropium
• Anoro Ellipta
• Bevespi Aerosphere
• Breo Ellipta
• Breztri
• budesonide/formoterol/glycopyrrolate inhaled
• Combivent Respimat
• Duaklir Pressair
• Dulera
• fluticasone furoate/umeclidinium bromide/vilanterol inhaled
• formoterol/budesonide inhaled
• glycopyrrolate inhaled/formoterol
• mometasone / formoterol
• salmeterol/fluticasone inhaled
• Stiolto Respimat
• Symbicort
• tiotropium/olodaterol inhaled
• Trelegy Ellipta
• umeclidinium bromide/vilanterol inhaled
• vilanterol/fluticasone furoate inhaled
• Wixela Inhub