Respiratory Puffers

Class / Combination Generic name(s) Representative brand name(s) Device type Strength (per actuation / blister) Typical adult dose (usual) Indications Typical minimum age (label) Key clinical notes for pharmacist
SABA (short-acting β₂ agonist) Salbutamol / Albuterol Ventolin HFA, ProAir HFA, Salamol MDI / HFA, some DPI/nebuliser solutions MDI: 100 μg (albuterol) per puff (varies by brand) 1–2 puffs q4–6h prn (up to ↑freq per label) Relief of acute bronchospasm; rescue inhaler for asthma/COPD Often ≥4–6 yrs for many MDIs (varies by product) Shake MDI, use spacer for children / poor technique; counsel on tachycardia, tremor. Check rescue inhaler supply. (See Ventolin label.) accessdata.fda.gov
SAMA (short-acting muscarinic antagonist) Ipratropium bromide Atrovent HFA MDI / nebulizer MDI: 21 μg per puff (varies) 2 puffs 4× daily (or nebulized 0.5 mg q6–8h) COPD bronchodilation; additive to SABA in COPD/asthma exacerbations Adults/children (product dependent) Useful in COPD; anticholinergic effects (dry mouth); caution glaucoma/urinary retention; spacer optional.
SABA + SAMA (combination for acute relief in some products) Salbutamol + ipratropium Combivent Respimat (ipratropium + albuterol) Soft mist inhaler (Respimat) e.g., 20 μg ipratropium / 100 μg albuterol per actuation (product dependent) 1 inhalation QID COPD exacerbations; occasionally used in severe wheeze Adults/adolescents per product Respimat requires specific technique (slow deep inhalation); counseling on priming and cleaning.
ICS (inhaled corticosteroid) Beclomethasone dipropionate Qvar, Clenil MDI / DPI e.g., 50–100 μg per actuation (product dependent) Varies by disease severity; titrate to lowest effective dose (e.g., 100–400 μg/day) Maintenance control of asthma; not rescue Many products from age 4–12 (product dependent) Counsel oral hygiene (rinse/spit to reduce thrush), bone/adrenal effects at high dose, monitor growth in children.
ICS Budesonide Pulmicort Flexhaler (DPI), Pulmicort Respules (nebuliser) DPI / nebuliser Flexhaler: 200 μg/actuation; Respules: 0.25–0.5 mg/2 mL Typical chronic dosing variable (e.g., 200–800 μg/day) Asthma maintenance (also COPD formulation use) Respules used in infants/children; check label Nebulized option for small children; rinse mouth after inhalation.
ICS (fluticasone propionate) Fluticasone propionate Flovent HFA/Diskus MDI / DPI e.g., 44/110/220 μg per actuation (product dependent) 100–500 μg twice daily depending on severity Asthma maintenance From 4 yrs (product dependent) Same ICS counselling; assess for adrenal suppression with high doses.
ICS/LABA Fluticasone propionate / Salmeterol Advair Diskus / Advair HFA (UK: Seretide) DPI / MDI (Diskus = DPI) e.g., 100/50, 250/50, 500/50 μg (fluticasone / salmeterol) 1 inhalation BID (strength per severity) Asthma maintenance; COPD (certain strengths/regions) From 4–12 yrs (product dependent); adults Titrate to lowest effective ICS dose; LABA should not be used as monotherapy for asthma; counsel on increased risk with single-agent LABA (combination products recommended). See Advair label (max 500/50 BID). accessdata.fda.gov+1
ICS/LABA Budesonide / Formoterol Symbicort MDI e.g., 80/4.5 μg, 160/4.5 μg per inhalation Maintenance: 1–2 inhalations BID (depending on strength); in some regions budesonide/formoterol may be used SMART (single-maintenance-and-reliever therapy) — check local guidance Asthma maintenance; COPD (specific products/strengths) From 6 yrs (asthma) for many formulations SMART regimen (use same inhaler as reliever) is product- and guideline-dependent — check local protocol. Refer to label for pediatric use and COPD approvals. accessdata.fda.gov+1
ICS/LABA Mometasone / Formoterol Dulera MDI e.g., 100/5 μg, 200/5 μg per actuation 2 inhalations BID (strength dependent) Asthma maintenance ≥12 yrs for many labels (confirm product) Counseling on ICS effects; not for acute relief. accessdata.fda.gov
ICS/LABA (once daily) Fluticasone furoate / Vilanterol Breo Ellipta DPI (Ellipta) 100/25 μg or 200/25 μg (mcg) per inhalation 1 inhalation once daily Asthma (certain strengths) and COPD maintenance Adults/adolescents (product label) Once-daily dosing improves adherence for some patients; avoid in acute bronchospasm. accessdata.fda.gov
LABA/LAMA (dual bronchodilator) Umeclidinium / Vilanterol Anoro Ellipta DPI (Ellipta) Umeclidinium 62.5 μg / Vilanterol 25 μg per inhalation 1 inhalation once daily COPD maintenance (not for asthma monotherapy) Adults Dual bronchodilator for COPD; anticholinergic/adverse effects; counsel on dry mouth, urinary retention, narrow-angle glaucoma. GSK Pro
LAMA (long-acting muscarinic antagonist) Tiotropium Spiriva HandiHaler (DPI), Respimat (soft mist) DPI (capsule) / Soft-mist inhaler HandiHaler: capsule 18 μg/inhalation; Respimat: 1.25–2.5 μg/actuation (product dependent) Once daily COPD maintenance; also approved as add-on in asthma (Respimat, select formulations) Adults; some inhaler labels include ≥6 yrs for asthma add-on (check label) HandiHaler requires capsule loading; Respimat requires priming; counsel on anticholinergic adverse effects and device technique.
ICS/LAMA/LABA (triple therapy) Fluticasone furoate / Umeclidinium / Vilanterol Trelegy Ellipta DPI (Ellipta) Fluticasone furoate 100 μg / Umeclidinium 62.5 μg / Vilanterol 25 μg per inhalation (example strength) 1 inhalation once daily COPD maintenance; in some regions asthma (specific approvals) Adults Consider in patients with persistent symptoms/exacerbations despite dual therapy. Monitor for typical ICS adverse effects and anticholinergic/β-agonist effects. accessdata.fda.gov
ICS/LAMA/LABA (alternative triple) Budesonide / Glycopyrronium / Formoterol Breztri Aerosphere MDI (Aerosphere) e.g., 320 μg budesonide / 14.4 μg glycopyrronium (as bromide) / 10 μg formoterol per actuation (label example) 2 inhalations BID (product dependent — follow label) COPD maintenance Adults Aerosphere MDI — check prime/clean instructions; dose frequency differs from Ellipta triple. See product monograph. accessdata.fda.gov+1

High-value clinical pharmacist points (summary)

  1. Rescue vs maintenance: Teach patients the difference — SABA (e.g., salbutamol) is rescue; ICS/LABA, LAMA, LABA/LAMA, ICS/LAMA/LABA are maintenance. Some budesonide/formoterol products are licensed/used for SMART (maintenance + reliever) strategies in asthma — align with local guidelines and product label.
  2. LABA safety: LABA monotherapy is contraindicated for asthma — always use in combination with ICS for asthma. For COPD, LABA or LAMA monotherapy may be used. (Refer to product labels and national guidelines.)
  3. Device technique is critical: MDI vs DPI vs soft-mist have different inhalation profiles (slow deep inhalation for Respimat/MDI with spacer; faster deep inhalation for DPI). Spacers improve MDI delivery in children/poor technique; some soft-mist inhalers and DPIs do not require spacers. Emphasize priming, cleaning, and dose counters.
  4. Adverse effects / monitoring:
    • ICS: local candidiasis (rinse mouth), dysphonia, adrenal suppression at high doses, bone density/growth monitoring in children.
    • LABA: tremor, tachycardia, hypokalemia (rarely); interaction with β-blockers.
    • LAMA: dry mouth, constipation, urinary retention, worsening narrow-angle glaucoma.
    • Triple therapies combine above risks — monitor accordingly. (See labels.) 
  5. Special populations:
    • Children: use age-specific formulations/strengths and devices (nebuliser options like budesonide Respules). Check individual product labels for pediatric approvals and dosing. 
    • Renal/hepatic: most inhaled therapies have minimal need for renal dose adjustment because of low systemic exposure, BUT some systemic absorption and hepatic metabolism (CYP) — watch interacting CYP inhibitors/inducers for certain drugs (e.g., vilanterol, formoterol interactions). Check product labeling. 
  6. Exacerbation management: Ensure patient has an action plan — when to escalate therapy, when to seek urgent care, when to use oral corticosteroids or antibiotics per guidelines.
Generic Name Brand Name(s) Indication
Short-Acting Beta-Agonists (SABA)
Salbutamol (Albuterol) Ventolin, ProAir, Airomir, Proventil Acute bronchospasm (asthma/COPD)
Terbutaline Bricanyl Acute bronchospasm (asthma/COPD)
Long-Acting Beta-Agonists (LABA)
Salmeterol Serevent Asthma, COPD (maintenance)
Formoterol Oxeze, Foradil Asthma, COPD (maintenance)
Indacaterol Onbrez Breezhaler COPD
Olodaterol Striverdi Respimat COPD
Inhaled Corticosteroids (ICS)
Fluticasone propionate Flovent HFA, Flovent Diskus Asthma
Budesonide Pulmicort Asthma
Beclomethasone Qvar Asthma
Mometasone Asmanex Asthma
Ciclesonide Alvesco Asthma
ICS + LABA Combination Inhalers
Fluticasone/Salmeterol Advair, Wixela, AirDuo Asthma, COPD
Budesonide/Formoterol Symbicort Asthma, COPD
Mometasone/Formoterol Dulera Asthma
Fluticasone furoate/Vilanterol Breo Ellipta Asthma, COPD
Long-Acting Muscarinic Antagonists (LAMA)
Tiotropium Spiriva Respimat/Handihaler COPD, Asthma (Respimat only)
Glycopyrronium Seebri Breezhaler COPD
Aclidinium Tudorza COPD
Umeclidinium Incruse Ellipta COPD
LAMA + LABA Combination Inhalers
Umeclidinium/Vilanterol Anoro Ellipta COPD
Tiotropium/Olodaterol Spiolto Respimat COPD
Glycopyrronium/Indacaterol Ultibro Breezhaler COPD
Aclidinium/Formoterol Duaklir Genuair COPD
Triple Therapy (ICS + LABA + LAMA)
Fluticasone furoate/Umeclidinium/Vilanterol Trelegy Ellipta COPD, Asthma (selected cases)
Budesonide/Glycopyrronium/Formoterol Breztri Aerosphere COPD

 

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