Fixed dose triple therapy in a pMDI for patients with moderate to very severe COPD
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14 FEBRUARY 2025 ausdoc . com . au
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A patient ’ s facial palsy and progressive neuropathy flag a serious diagnosis to his GP , whose advocacy leads to appropriate diagnosis and management .
Dr Behzad Rafiee GP in Brisbane , Queensland .
JACK is a 23-year-old retail worker who presents to his GP with five days of left facial palsy , with a working diagnosis of Bell ’ s palsy . He describes associated recent and repeated viral symptoms and intermittent dry cough , myalgia and fatigue . COVID-19 and influenza RATs are negative
He initially attended a private emergency care centre five nights ago and was prescribed oral valaciclovir 1g tds and oral prednisone 75mg daily for five days , for Bell ’ s palsy .
He was no better after four days of treatment , so then presented to the local tertiary ED .
In the hospital , he was found to have normal vital signs . Cranial nerve examination was in keeping with left-sided Bell ’ s palsy . Upper limb neurological examination revealed altered sensation in the right ulnar nerve distribution and left upper limb , generally . Lower limb neurological findings were reported to be fluctuating , with varying degrees of bilateral altered sensation of both feet .
FBC and EUC were normal and the ED discharged Jack to his GP for viral investigations including Epstein – Barr virus , STI screen and neurology referral if the fluctuating neurology persisted .
Jack ’ s past medical history includes lumbar disc herniation , anxiety , depression , OCD and acne .
He is a non-smoker and non-drinker and takes occasional diazepam as prescribed for anxiety .
GP review
Upon presenting to the GP a day later , he describes worsening numbness and pins and needles of the feet , with generalised myalgia , a sore left temple and bilateral maxillae .
On examination he looks anxious and withdrawn . He is afebrile , BP is 168 / 89mmHg and pulse is 106bpm .
He has an erythematous papular rash on his torso , with excoriation . Cardiovascular and respiratory examinations are normal .
Neurological examination confirms left facial paresis , altered sensation of upper and lower limbs but no demonstrable sensory level or dermatomal distribution .
He is referred for viral and STI screening , as well as inflammatory markers , vitamin B12 , folate and TSH , and a brain MRI .
Investigations
The only MRI finding is fluid within the left mastoid sinus . There is no pathologic enhancement along the left facial nerve to indicate typical Bell ’ s palsy and no intracranial abnormalities .
His pathology is unremarkable , apart from HSV immunoglobulin M which is positive , consistent with recent infection .
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Fixed dose triple therapy in a pMDI for patients with moderate to very severe COPD
SCAN TO ORDER BREZTRI ® SAMPLE
INDICATION : BREZTRI AEROSPHERE ® is indicated as a maintenance treatment to prevent exacerbations and relieve symptoms in adults with moderate , severe , or very severe COPD who require treatment with a combination of ICS , LABA , and LAMA . 1 BREZTRI AEROSPHERE ® is not indicated for the initiation of therapy in COPD . 1 SAFETY : In ETHOS , adverse events that occurred in ≥3 % of patients overall for BREZTRI ® and GLY / FORM were nasopharyngitis , COPD , upper respiratory tract infection , pneumonia and bronchitis . 2 The incidence of confirmed pneumonia was 4.2 % with BREZTRI ® and 2.3 % with GLY / FORM . 1 , 2 Please review Product Information for information on other Precautions and Adverse Effects .
PBS Information : Authority required ( STREAMLINED ) for the treatment of COPD . Refer to PBS for full authority information .
PLEASE REVIEW FULL PRODUCT INFORMATION BEFORE PRESCRIBING . PRODUCT INFORMATION AVAILABLE ON REQUEST FROM ASTRAZENECA ON 1800 805 342 OR WWW . ASTRAZENECA . COM . AU / PI OR BY SCANNING THIS QR CODE .
SCAN QR CODE to see full BREZTRI ® Product Information
COPD = chronic obstructive pulmonary disease ; FORM = formoterol ; GLY = glycopyrronium ; ICS = inhaled corticosteroid ; LABA = long-acting beta 2 agonist ; LAMA = long-acting muscarinic antagonist ; pMDI = pressurised Metered Dose Inhaler . References : 1 . BREZTRI AEROSPHERE ® Approved Product Information . 2 . Rabe F et al . N Engl J Med . 2020 ; 383 ( 1 ): 35 – 48 .
BREZTRI ® and AEROSPHERE ® are registered trademarks of the AstraZeneca group of companies . Registered user AstraZeneca Pty . Ltd . ABN 54 009 682 311 . 66 Talavera Road , Macquarie Park , NSW 2113 . www . astrazeneca . com . au . For Medical Information enquiries or to report an adverse event or product quality complaint : Telephone 1800 805 342 or via https :// contactazmedical . astrazeneca . com . 2743 . AU-21580 . January 2025 .
AU-21580 - 2743 BREZTRI Media Placements 2025 _ ADG _ 260mmW x 133mmH _ v1 _ 02-FA . indd 1 23 / 1 / 2025 5:29 pm