|
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)
|
|
|
|
|
