Bevespi® Inhaler Approved by FDA

Many of you may have seen the recent press release about the new drug Bevespi® that has been approved for COPD by the FDA. This new medication combines 2 classes of drugs that are commonly used for COPD maintenance therapy: long-acting anticholinergics or muscarinics (LAMA) and long-acting beta-2 agonists (LABA).  

Long-acting and short-acting drugs

Long-acting drugs typically provide the benefit of having to take the medication only once or twice a day and are used to prevent exacerbations or “flare-ups”, reduce symptoms and improve exercise tolerance. One important thing to remember about any long-acting medication is that they are used only for maintenance, only a short-acting drug will help when you are actively having symptoms or a “flare-up”.

You may already be familiar with these classes of long-acting combination drugs because there are several medications currently on the market that are similar. Two examples are ANORO® ELLIPTA® and UTIBRON™ NEOHALER®, these are powder inhalers that combine a long-acting beta-2 agonist and a long-acting anticholinergic.

Bevespi® is a combination therapy that delivers the medication using a pressurized metered-dose inhaler (pMDI).  According to the manufacturer, this new medication utilizes a new technology that provides “consistent delivery of one or more different medicines from a single pMDI” using “co-suspension technology”¹.

Particles sticking together

Sometimes when more than one medication is combined in an inhaler, some of the particles from the two medications can begin to “stick together” and make bigger particles and this can affect the amount of drug that will deposit in the tiny airspaces. The tiny airspaces are our target, this is where we want the medication to go.  The makers of Bevespi® are stating that what makes their product unique is that they have a technology that prevents this “sticking together” and efficiently delivers the medication to the tiny airspaces using a pressurized metered-dose inhaler (pMDI)².

Drug deposition

Inhaled medications are a type of aerosol called “medical aerosols”. These medical aerosols are made up of drug particles suspended in gas. The primary focus of any inhaled medication is getting the maximum amount of drug into the areas of the lung where it is needed. We call this “drug deposition.” This happens when drug particles land on the inside of your airways - think of falling snowflakes landing on the ground.  We want the drug to deposit in the furthest areas of the lung, in the tiny airspaces that connect to the tiny air sacs where oxygen and carbon dioxide are exchanged. To accomplish this there are some things that will affect medication delivery to the tiny airspaces:

1. The type of medication and how big its particles are.
   • Does the medicine do what it is supposed to do? Are the particles the right size to be able to travel to the smallest areas of the lung?
2. How the medication is delivered.
   • Inhaled medications can be delivered with a pressurized metered-dose inhaler (pMDI), a dry-powder inhaler (DPI) or a small-volume nebulizer (SVN).
   • A pMDI delivers medication as a mist or spray from a pressurized canister.
   • A DPI delivers medication in a dry powder form.
   • A SVN uses a nebulizer cup, which holds the liquid medication.
3. The condition of your lungs.
   • For example, if you have a lot of sputum or if you are experiencing a sudden “flare-up” of symptoms, these may affect how much medicine is deposited.
4. How you use the delivery device.
   • This is especially important with a pMDI and DPI. Inhaler technique can have a tremendous effect on the amount of medication that is deposited in the lung.
   • For example, some devices may require you do take a slow deep breath and hold it for a few seconds, if you do not do this, it may affect how much medication gets down to the tiny airspaces.

Medication tailored to you

What medication is prescribed for you will depend on the stage of your COPD, the availability and cost of the medication, and your response to the therapy. We are fortunate to live in a time where we have so many medication options available to us, but all of these choices can sometimes be very confusing!  It is important to be an active member of your healthcare team and maintain an open dialogue about how you are feeling and what your goals are.  By being actively engaged, you can be a part of creating a treatment plan that is specifically tailored to you!