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SUGGESTED SEQUENCE FOR USE
OF MULTIPLE INHALERS |
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If Using
ONLY Long-acting Medications |
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If using BOTH Short & Long-acting Medications |
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▼ |
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▼ |
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FIRST |
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FIRST
(see Note 3) |
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Long-acting β-agonist (alone or combined) |
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Long-acting β-agonist (alone or combined) |
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Brovana (arformorterol) |
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Brovana (arformorterol) |
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Foradil (formoterol),
Performist (formoterol) |
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Foradil (formoterol),
Performist (formoterol) |
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Oxis,
Oxese (formoterol) |
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Oxis,
Oxese (formoterol) |
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Serevent (salmeterol) |
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Serevent (salmeterol) |
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Advair (Serevent
& Flovent) |
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Advair (Serevent
& Flovent) |
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Duova (formoterol
& tiotropium bromide) |
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Duova (formoterol
& tiotropium bromide) |
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Seretide (salmetrol
& fluticasone) |
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Seretide (salmetrol
& fluticasone) |
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Symbicort
(formoterol & budesonide) |
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Symbicort
(formoterol & budesonide) |
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▼ |
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SECOND |
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SECOND |
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Long-acting Anticholinergic |
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Long-acting Anticholinergic |
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Spiriva (tiotropium
bromide) |
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Spiriva (tiotropium
bromide) |
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Tiova (tiotropium
bromide) |
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Tiova (tiotropium
bromide) |
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(Also,
see note 4) |
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(Also,
see note 4) |
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▼ |
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▼ |
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LAST |
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THIRD |
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Steroid |
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Steroid |
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Aerobid,
Aerospan HFA (flunisolide) |
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Aerobid,
Aerospan HFA (flunisolide) |
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Asmanex (mometasone)
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Asmanex (mometasone)
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Azmacort (triamcinolone) |
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Azmacort (triamcinolone) |
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dexamethasone |
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dexamethasone |
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Flovent, -HFA,
-Diskus (fluticasone) |
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Flovent, -HFA,
-Diskus (fluticasone) |
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Pulmicort
(budesonide) |
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Pulmicort
(budesonide) |
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QVAR,
Vanceril (beclomethasone) |
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QVAR,
Vanceril (beclomethasone) |
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▼ |
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NOTES: |
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LAST |
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(1.)
Take short-acting drugs at least 2 hours |
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Short-acting β-agonist (alone or combined) |
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before
long-acting drugs in the same class to |
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albuterol
(salbutamol in UK) |
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avoid
interfering with the long-acting drug's action. |
Alupent (metaproterenol) |
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Berotec
(Canada) (feneterol) |
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(2.)
If albuterol is used on a regular scheduled |
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Bricanyl (terbutaline) |
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Basis, always
take it after the long-acting |
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Bronkosol
(isoetharine) |
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β-agonist,
and never less than 2 hours before it. |
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Maxair (pirbuterol) |
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Medihaler-Iso, Isuprel (isoproterenol) |
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(3.)
If you must use albuterol on a "rescue" |
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ProAir, -HFA (albuterol) |
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basis, then
wait two hours before taking a |
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Proventil,
-HFA
(albuterol) |
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long-acting
β-agonist. |
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Ventolin,
Airomir (Canada) (albuterol) |
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Xopenex, -HFA
(levalbuterol) |
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(4.)
If Atrovent is used in addition to Spiriva/ |
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Combivent
(Atrovent & albuterol) (see note 4) |
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Tiova,
always take it after the Spiriva/ |
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Mark
Mangus, BSRC, RPFT, RRT |
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Tiova, and
never less than 2 hours before it. |
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3/27/2006
(Rev2: 7/17/2007) |
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