The Active Ingredient: Indacaterol
Onbrez delivers indacaterol, a long-acting $\beta_2$-adrenergic agonist (LABA), which is the medication's active ingredient. Inhaled indacaterol works locally in the lungs to achieve its therapeutic effect. The mechanism of action involves stimulating intracellular adenyl cyclase, an enzyme that increases levels of cyclic adenosine monophosphate (cAMP). This rise in cAMP concentration causes the smooth muscles surrounding the airways to relax, thereby helping to keep them open. This process makes breathing easier and helps to alleviate symptoms such as wheezing and shortness of breath associated with COPD. A key pharmacological feature of indacaterol is its combination of rapid onset and long duration of action, which allows for convenient, once-daily dosing.
Indications and Proper Use
What conditions does Onbrez treat?
Onbrez is exclusively indicated for the maintenance bronchodilator treatment of airflow obstruction in adult patients with chronic obstructive pulmonary disease (COPD). COPD encompasses conditions like chronic bronchitis and emphysema. It is crucial to understand that Onbrez is a maintenance medication designed for regular, long-term use and is not a rescue inhaler for managing acute symptoms or sudden, severe COPD exacerbations. For immediate relief of sudden breathing difficulties, a separate short-acting inhaler is required.
Is it suitable for asthma?
Warning: Onbrez is not indicated for the treatment of asthma. Studies have shown that other LABA medications, when used alone in asthma patients, may increase the risk of asthma-related death. The safety and efficacy of Onbrez have not been established in asthma patients, and therefore, it should only be used to treat COPD.
How to use the Breezhaler device
Onbrez is administered using a dry powder inhaler called the Breezhaler device, which is designed to be used with the corresponding Onbrez capsules. The capsules are not meant to be swallowed. Here is a general guide to its use:
- Preparation: First, remove the cap from the Breezhaler device.
- Open the device: Hold the base firmly and tilt the mouthpiece to open the device.
- Insert the capsule: Immediately before use and with dry hands, take one capsule from the blister pack and place it in the capsule chamber. Never place the capsule directly into the mouthpiece.
- Close the device: Close the mouthpiece until you hear a definitive 'click'.
- Pierce the capsule: Hold the inhaler upright and press both piercing buttons on the sides simultaneously, then release. You should hear a soft clicking sound as the capsule is pierced.
- Inhale the medication: Exhale completely away from the inhaler. Place the mouthpiece in your mouth and inhale rapidly and deeply. You should hear a whirring sound as the capsule spins.
- Hold your breath: Remove the inhaler from your mouth and hold your breath for at least five seconds or as long as comfortable.
- Exhale and discard: Exhale gently and discard the empty capsule from the device.
Side Effects and Contraindications
Common side effects
While Onbrez is generally well-tolerated, some common side effects have been reported, including:
- Cough, particularly immediately after inhalation
- Headache
- Upper respiratory tract infections, such as nasopharyngitis
- Muscle spasms
Serious side effects
In some cases, more serious side effects can occur, and medical attention should be sought immediately for symptoms such as:
- Difficulty breathing or allergic reactions, including swelling of the face, lips, and tongue
- Fast or irregular heartbeat, or chest pain
- Paradoxical bronchospasm, where the airways constrict immediately after inhalation
Important warnings and contraindications
Onbrez may not be suitable for everyone. It is contraindicated in patients with a known hypersensitivity to indacaterol or lactose. Patients with pre-existing heart problems, hypertension, diabetes, or hypokalemia should use caution and inform their doctor.
Onbrez vs. Other COPD Medications
Many options are available for COPD management, and Onbrez is one of several long-acting bronchodilators. The following table provides a general comparison with two other common classes of inhaled medications.
| Feature | Onbrez (Indacaterol) | Tiotropium (Spiriva) | Twice-Daily LABAs (e.g., Salmeterol, Formoterol) |
|---|---|---|---|
| Drug Class | Ultra-long-acting beta-2 agonist (LABA) | Long-acting muscarinic antagonist (LAMA) | Long-acting beta-2 agonist (LABA) |
| Mechanism | Relaxes smooth muscle by stimulating $\beta_2$-receptors | Blocks muscarinic receptors to relax airway muscles | Stimulates $\beta_2$-receptors to relax smooth muscle |
| Dosing Frequency | Once-daily | Once-daily | Twice-daily |
| Speed of Onset | Rapid (within 5 minutes) | Slower than Onbrez | Slower than Onbrez |
| Efficacy (FEV$_1$ Improvement) | Shown to be superior to twice-daily LABAs | Effective, but comparative results vary by study | Effective, but generally less potent than indacaterol based on studies |
| Impact on Dyspnea | Demonstrates significant improvement | Effective, but comparative results vary by study | Effective, but can be inferior to indacaterol |
| Device | Breezhaler dry powder inhaler | HandiHaler or Respimat inhalers | Various dry powder or metered-dose inhalers |
Conclusion
An Onbrez inhaler, delivering the active drug indacaterol via the Breezhaler device, is an effective and convenient once-daily option for the long-term management of COPD. Its rapid onset of action and sustained 24-hour effect help to improve lung function, reduce breathlessness, and enhance the quality of life for patients. However, it is a maintenance therapy and not suitable for acute exacerbations or for the treatment of asthma due to safety concerns. Patients should always consult with their healthcare provider to ensure that Onbrez is the appropriate medication for their specific condition and to understand all aspects of its use, including potential side effects. For comprehensive prescribing information, refer to official regulatory documents from the European Medicines Agency (EMA).
