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Previously Suggested Inhaler Sequence



SUGGESTED SEQUENCE FOR USE OF MULTIPLE INHALED MEDICATIONS

 

 

 

 If Using ONLY Long-acting Medications

 

If using BOTH Short & Long-acting Medications

 

FIRST

 

FIRST (see Note 3)

Long-acting β-agonist (alone or combined)

 

Long-acting β-agonist (alone or combined)

   Brovana ( arformorterol )

 

   Brovana ( arformorterol )

  Foradil ( formoterol ), Performist ( formoterol)

 

  Foradil ( formoterol ), Perforomist ( formoterol)

  Oxis, Oxese ( formoterol )

 

  Oxis, Oxese ( formoterol )

  Serevent ( salmeterol )

 

  Serevent ( salmeterol )

  Advair ( Serevent & Flovent )

 

  Advair ( Serevent & Flovent )

  Duova ( formoterol & tiotropium bromide )

 

  Duova ( formoterol & tiotropium bromide )

  Seretide ( salmetrol & fluticasone )

 

  Seretide ( salmetrol & fluticasone )

  Symbicort ( formoterol & budesonide )

 

  Symbicort ( formoterol & budesonide )

 

SECOND

 

SECOND

Long-acting Anticholinergic

 

Long-acting Anticholinergic

   Spiriva ( tiotropium bromide )

 

   Spiriva ( tiotropium bromide )

   Tiova ( tiotropium bromide )

 

   Tiova ( tiotropium bromide )

   (Also, see note 4)

 

   (Also, see note 4)

 

LAST

 

THIRD

Steroid

 

Steroid

  Aerobid, Aerospan HFA ( flunisolide )

 

  Aerobid, Aerospan HFA ( flunisolide )

  Asmanex ( mometasone )

 

  Asmanex ( mometasone )

  Azmacort ( triamcinolone )

 

  Azmacort ( triamcinolone )

  dexamethasone

 

  dexamethasone

  Flovent, -HFA, -Diskus ( fluticasone )

 

  Flovent, -HFA, -Diskus ( fluticasone )

  Pulmicort ( budesonide )

 

  Pulmicort ( budesonide )

  QVAR, Vanceril ( beclomethasone )

 

  QVAR, Vanceril ( beclomethasone )

 

 

NOTES:

 

LAST

(1.) Take short-acting drugs at least 2 hours

 

Short-acting β-agonist (alone or combined)

before long-acting drugs in the same class to

 

  albuterol ( salbutamol in UK )         

avoid interfering with the long-acting drug's action.

  Alupent ( metaproterenol )

 

 

  Berotec (Canada) ( feneterol )

(2.) If albuterol is used on a regular scheduled  

 

  Bricanyl ( terbutaline )

 Basis,   always take it after the long-acting

 

  Bronkosol ( isoetharine )

β-agonist, and never less than 2 hours before it.

 

  Maxair ( pirbuterol )

 

 

  Medihaler-Iso, Isuprel ( isoproterenol )

(3.) If you must use albuterol on a "rescue"

 

  ProAir, -HFA ( albuterol )

basis, then wait two hours before taking a

 

  Proventil, -HFA ( albuterol )

long-acting β-agonist.

 

  Ventolin, Airomir (Canada) ( albuterol )

   

  Xopenex, -HFA ( levalbuterol )

(4.) If Atrovent is used in addition to  Spiriva/

 

  Combivent ( Atrovent & albuterol ) (see note 4)

 Tiova,  always  take it after the Spiriva/

 

Mark Mangus, BSRC, RPFT, RRT

Tiova, and never less than 2 hours before it.

 

3/27/2006   (Rev2: 7/17/2007)