Onbrez Breezhaler

Onbrez Breezhaler is a prescription inhaler containing indacaterol, a long-acting beta-2 adrenoceptor agonist (LABA) used in the maintenance treatment of chronic obstructive pulmonary disease (COPD) in adults. Delivered via the innovative Breezhaler dry-powder inhaler device, Onbrez provides 24-hour bronchodilation from a single daily inhalation, helping to reduce breathlessness, improve exercise tolerance, and decrease exacerbation frequency in patients with COPD.

Mechanism of Action

Indacaterol exerts its effects by selectively stimulating beta-2 adrenoceptors in the smooth muscle of the airways. This stimulation activates adenylate cyclase, increasing intracellular cyclic AMP (cAMP) levels. Elevated cAMP activates protein kinase A, which phosphorylates myosin light chain kinase and inhibits smooth muscle contraction, causing relaxation of bronchial smooth muscle and widening of the airways. The onset of bronchodilation occurs within five minutes of inhalation, which is unusually rapid for a LABA, making Onbrez useful as both a maintenance bronchodilator and for providing some relief from acute breathlessness. The duration of action exceeds 24 hours, supporting once-daily dosing.

Role in COPD Management

Onbrez is indicated exclusively for COPD and must not be used to treat asthma. LABAs are recommended as a first-line maintenance bronchodilator in COPD by NICE guidelines, either as monotherapy or in combination with a long-acting muscarinic antagonist (LAMA). Indacaterol, when used once daily, has been shown in clinical trials to significantly improve lung function (FEV1), reduce dyspnoea, improve health-related quality of life, and reduce the frequency of exacerbations compared with placebo. Onbrez does not provide rapid relief of acute breathlessness and should always be accompanied by a short-acting rescue inhaler (such as salbutamol) for use during acute exacerbations.

How to Use the Onbrez Breezhaler

Onbrez (indacaterol) is delivered via the Breezhaler inhaler device, which punctures a capsule to release a dry powder for inhalation. The capsules must never be swallowed — they are for inhalation only.

To use: remove the cap, open the inhaler by tilting the mouthpiece, place one capsule in the capsule chamber, close the inhaler, and pierce the capsule by pressing both side buttons at the same time. Breathe out fully away from the mouthpiece, then inhale forcefully and deeply through the mouthpiece. A whirring sound confirms the capsule is spinning and the powder is being released. Hold your breath for 5 to 10 seconds after inhaling. Check the capsule — if powder remains, inhale once more.

Once-Daily Use

Onbrez is used once daily at the same time each day. It is a long-acting bronchodilator (LABA) for COPD maintenance and should be used every day, even when you feel well. It is not a rescue inhaler and will not help during a sudden breathing episode. Always keep a short-acting reliever inhaler (such as salbutamol) available for acute symptoms.

• Standard adult dose: 150mcg inhaled once daily (one capsule via Breezhaler device)
• Higher dose: 300mcg once daily may be prescribed if additional bronchodilation is needed and tolerated

Onbrez is not licensed for use in patients under 18 years, or in patients with asthma. No dose adjustment is required for mild to moderate renal impairment or mild to moderate hepatic impairment. Caution is advised in severe hepatic impairment as indacaterol pharmacokinetics have not been fully characterised in this population.

Each Breezhaler capsule is for single use -- discard after inhalation regardless of whether all powder appears to have been inhaled. Check the capsule after inhalation; if powder remains, another inhalation from the same capsule may be taken. The Breezhaler device should be cleaned with a dry cloth or dry brush periodically to prevent powder build-up.

Common Side Effects

• Cough immediately after inhalation (brief and harmless — the powder can tickle the throat)
• Nasopharyngitis (cold-like symptoms)
• Upper respiratory tract infection
• Headache
• Sinusitis
• Nausea or indigestion
• Muscle pain or joint aches

Cardiac Effects

Onbrez, like other long-acting beta-agonists, can occasionally cause a faster or irregular heartbeat, particularly at the start of treatment. If you notice persistent palpitations, chest discomfort, or worsening shortness of breath, speak to your doctor. Do not use Onbrez for asthma — it is licensed only for COPD in adults, not for asthma treatment.

Not for Asthma or Acute COPD

Onbrez must not be used to treat asthma. LABA monotherapy (without inhaled corticosteroids) in asthma is associated with an increased risk of severe, potentially life-threatening asthma attacks. COPD and asthma require different treatment strategies, and using a COPD inhaler for asthma is dangerous.

Onbrez is a maintenance bronchodilator and is not a rescue medication. Do not use it to treat acute breathlessness or wheezing. If your breathlessness worsens acutely, use your short-acting rescue inhaler (salbutamol or similar) and seek medical advice if your condition does not improve promptly.

Drug Interactions and Cardiovascular Considerations

Beta-2 agonists should be used with caution alongside other sympathomimetic agents, as additive cardiovascular effects may occur. Non-selective beta-blockers (including eye drops containing timolol) may antagonise the bronchodilatory effect of indacaterol and can precipitate bronchospasm in patients with COPD.

Caution is also required in patients with known cardiovascular disease, hypertrophic obstructive cardiomyopathy, tachyarrhythmias, or hyperthyroidism. Concomitant use with QT-prolonging medications should be carefully reviewed.

Onbrez Breezhaler is contraindicated in:

• Known hypersensitivity to indacaterol maleate or any excipient in the formulation
• Asthma (not licensed or safe for this indication as LABA monotherapy)
• Patients under 18 years of age (safety and efficacy not established)

Use with caution in:

• Patients with cardiovascular disease (ischaemic heart disease, arrhythmias, hypertensive heart disease)
• Patients with hypertrophic obstructive cardiomyopathy or QT prolongation
• Patients on MAO inhibitors or tricyclic antidepressants (enhanced cardiovascular effects)
• Patients on non-selective beta-blockers (risk of bronchospasm and loss of bronchodilation)
• Patients with hypokalaemia risk (concomitant diuretics, theophylline, or corticosteroids)
• Patients with diabetes mellitus (monitor blood glucose)