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Onbrez and Spiriva: A Winning Combination

By February 19, 2011

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Many of you use the long-acting, anticholinergic bronchodilator Spiriva for daily maintenance treatment of COPD. According to a recent study, combining Spiriva Handihaler with the Onbrez Breezhaler works better to improve lung function than just using Spiriva alone.

Onbrez is a relatively new, long-acting beta agonist bronchodilator manufactured by the drug company, Novartis. So new, in fact, it has not yet met with FDA approval in the United States. It is currently being used however, in the European Union as well as in 50 other countries. The FDA advisory committee will be discussing its approval for the US market in March of this year.

While Onbrez and Spiriva are both bronchodilators, each has a different mode of action. Both drugs open up the airways and make breathing easier for people with COPD. Combining bronchodilators of different classes is recommended by the Global Initiative for Obstructive Lung Disease (GOLD) as part of the standard treatment guidelines for COPD.

To learn more about the study, read the press release at Pharmabiz.

If you are from the European Union or another country in which Onbrez is approved and have used this drug, please share your comments about its effectiveness below.

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February 24, 2011 at 10:59 pm
(1) Greg says:

My mother was diagnosed at the end of 2002 with emphysema and COPD. She was prescribed Spiriva, Advair, Albuterol Sulfate and Combivent as a rescue inhaler. For the first year and a half most of these medications/treatments worked for a while until the effects wore off.

I noticed that after a while they all stopped working and my mother refused the treatments. Albuterof Sulfate was first which was replaced with DuoNeb which included iapatropium bromide which was also in the Combivent. It worked for a while and then offered no relief. The same results with the Advair and eventually even the Combivent failed to provide the relief it had at the beginning.

I started my mother on a diet of fresh uncontaminated meat and raw vegetables, half steamed and half in a salad. Her supplemental oxygen requirement went from 4 liters to 3 however, it took 3 months for this improvement.

One thing I noticed about the drugs was that as soon as the effects wore off the benefits also disappeared.

When I asked my mother’s doctor what was making her emphysema get worse two years after she quit smoking thinking he would know. He told me they didn’t know and that it was a mystery!

February 25, 2011 at 12:46 pm
(2) copd says:

Your mother’s emphysema got worse because COPD is a progressive illness. Generally speaking, when you quit smoking, your lung function declines at the same rate of anyone else’s. But, it still declines. And, there are also some who are considered rapid decliners, in spite of quitting. I wrote an article about it here:


Read it, and if you have any questions, email me at copd(dot)guide(at)about.com.

February 25, 2011 at 6:50 pm
(3) copd says:

One more thing I wanted to mention is, many times people feel the drugs aren’t working, but, it is because they are misusing the inhaler and not getting its full benefit because of this. That’s why I just recently did another blog post about that topic. It can be found here: http://copd.about.com/b/2011/02/16/many-with-asthma-copd-may-misuse-inhalers.htm. It is very important to make sure you are using your inhaler correctly, and I include many how to’s in the above link. When a patient feels that their inhaler medications are no longer working and they are using them correctly, then this is when a trip to the doctor would be recommended to see if there is something else that can be added or, if maybe there is something else going on, like a worsening of COPD that requires a different approach, or, maybe something unrelated.

February 28, 2011 at 1:53 pm
(4) mautene says:

I had been taking Spiriva plus a Salbutamol inhalor. I started Onbrez with Spiriva 2 weeks ago and have not needed my Salbutamol for over a week. Yes the Onbrez makes me cough as it warns it may do. However at my Doctors suggestion, I have slowed down the inhalation a little on my first breath, rather than taking it in quickly on my first intake of breath. I do a quick one that empties the cartridge for my second inhalation. That seems to help me much better. I also like the fact that as it is a clear cartridge or capsule, you can see that it is empty too.

Hopes this helps anyone considering this regime or having problems using Onbrez. For me it is definitely helping.

March 1, 2011 at 6:37 am
(5) copd says:

Thanks, Mautene, that is really great information that I am sure will be of benefit to those who are able to get this drug.

March 3, 2011 at 8:25 pm
(6) Cheryl says:

Please let us know if the FDA approves or disapproves it.

By chance, I used Spiriva and then immediately had to climb up stairs. I had to breathe in deeply 3 or 4 times because I was out of breath once at the top. BUT, I could breath better all day! I’ve tried that several days and it seems to work.

July 1, 2011 at 4:48 am
(7) Don says:

Now into July and don’t see anything new about FDA approval of OnBreez

August 15, 2011 at 8:13 am
(8) S.Radhakrishnan says:

Onbreze I have got it from UK and I want to use it along with SPIRIVA. But I wanted to know which I should Inhale first.On Brezee or SPIRIVA for my Emphysema
Tomorrow 17th August is the day I wanted to start this trial.
If any one has tried please let me know by e-mail immedeately.
I hope I get Better with Onbrezee and SPIRIVA combination.

August 18, 2011 at 11:50 am
(9) Daniel de Argentina says:

Soy un paciente masculino de 52 años con epoc grado IV por deficiencia de alfa1 antritipsina.
Uso Spiriva y desde hace dos meses me han indicado Onbrez (Onbrize en Argentina).
En mi caso, este último broncodilatador no ha aportado ninguna mejora significativa al efecto que lograba con Spiriva solamente.
A esto hay que sumarle el alto precio que tiene este fármaco (80 dolares en Argentina), con lo que el costo/beneficio no es nada tentador.
Recomiento ampliamente la rehabilitación respiratoria con un kiropráctico. Es un tratamiento natural y con muy buenos resultados comprobables, sin efectos colaterales que pueden (seguramente) tener las nuevas drogas y que aún no se conocen

August 18, 2011 at 12:09 pm
(10) Daniel from Argentina says:

I am a 52 year old male patient with COPD stage IV alpha1 antitripsina deficiency.
Use Spiriva and for two months I have indicated Onbrez (Onbrize in Argentina).
In my case, the latter bronchodilator has not provided any significant improvement to the effect achieved with Spiriva only.
To this we must add the high price this drug (80 dollars in Argentina), with the cost / benefit is not tempting.
I highly recommend a respiratory rehabilitation.
It is a natural treatment with very good results provable without side effects that can (probably) be new drugs that are not yet known

September 20, 2011 at 9:17 am
(11) Matt says:


Just found this thread…

I have been taking Spiriva for more than a year – recently read about Onbrez being better (?).

As the Onbrez costs less than Spiriva i asked my UK Doctor if I could try it…so have been on Onbrez for 6 days only…our drugs are of course free (after paying 11% NHS for a lifetime!)

Cannot say it is better than Spiriva at this short time and have stopped the Spiriva in the meantime…might try them together later after I can judge the effect of the Onbrez alone.


November 21, 2011 at 1:30 am
(12) evie yarnold says:

I have been an asthmatic since i was in my early twenties,and I just had my seventhy birthday, and have been on various in halers allmy life, at the moment I am taking singulair, bronhodual, INNOVAIR? antihestime, ventoline and because I also suffer from cronic sianicitus I take Nasonex, and I take these all on a daily basis suppose to be for the rest of my life, but because I have lived in France for five years in Brittiany, which we were not aware of at the time, is very damp and not at all suitable for COPD patients, they have send me for the last two years for a treatment, you need the reveral of the Doc , and Specialist, and quite a bit of form filling involved, you can also pick the time which is suitable for you , providing they can fit you in offcource, but all these Thermes centres are enormesly popular for all sorts of ailments here, they are for three weeks and the “cure” as they call it here is all naturel, you can schoose your own accommadtion too!!we stayed on a campside for three weeks and the treatment is daily for two hours, it seems to be very popular here in france i dont think the treatment is available in the UK and it really makes a big difference during the winter for me,The Doc has promised me to prescribe the new wonder drug Onbreze,(not my words) hope to hear from anybody who has had long term COPD, just to let you know that with all this treatment, I sing in three choirs and swimm on a regular basis and walk quite a lot, but only on the flat offcourse!! all the best to everybody out there……………

January 20, 2012 at 1:25 pm
(13) Don says:

Is OnBreez now available in the U.S., as we are into 2012

August 18, 2012 at 5:35 am
(14) jan devon says:

I have tried ONBREZ for ten days and seem to be far worse than when on SPIRIVA. I note with interest that these two drugs can be taken together, Does anyone have any experience of how to go about this?

grateful for any comments,,,,jan

August 18, 2012 at 5:51 am
(15) jan devon says:

what effect does the weather have on you? jan

August 23, 2012 at 12:12 pm
(16) copd says:

Great question. Extreme weather can have different effects on different people. Extreme cold can cause bronchospasm, as does extreme heat. People with COPD are encouraged to cover their nose and mouth with a scarf or mask, like brofilma, when extremely cold weather strikes. In contrast, people with COPD should try to avoid going outdoors on extremely hot days, especially when there are weather alerts. Great topic idea for an article. Thanks.

August 26, 2012 at 10:02 am
(17) jan devon says:

thanks for reply to weather question. still waiting to find out how to take Onbrez and Spiriva together. Which one to take first and what dosage? Please help! Many thanks!

August 27, 2012 at 5:40 pm
(18) copd says:

The recommended once-daily dose of Onbrez is inhalation of one, 150 microgram capsule using the Onbrez Breezhaler. The recommended once-daily dose of Spiriva is two inhalations of the powder contents of one 18 microgram SPIRIVA capsule used with the HandiHaler device. As far as using them together and which should come first, you have to ask your doctor about that.

September 10, 2012 at 9:52 pm
(19) margaret says:

The specalist i go to advised using Onbrex first and then using the Onbrez inhailer taking the Spirava- this was on the 10/11/12

September 21, 2012 at 5:33 am
(20) jan devon says:

Thanks Margaret
My Spiriva is taken as an inhaled spray, is yours in capsule form?
The British Lung Foundation have not yet had any feedback on Onbrez. what National Health district are you as the South West area does not also have any advice they can give me?
Can you tell me if taking them together has made any significant difference and if it has how long before you noticed any effects.
Yours hopefully

September 21, 2012 at 6:25 am
(21) jan devon says:

Thanks Margaret
I have spoken to the British Lung Foundation and they can give no advice on how to use these two together.
I take inhaled spray, do you take this in capsule form? Which National Health area are you in as no one in the South West seems to know how to take these?
I am grateful for any info you can give me.
Yours hopefully

February 5, 2014 at 12:10 pm
(22) Reginald Eisele says:

I´m on Spiriva & Onbrez. Onbrez in the morning with Pulmicort and Spiriva before going to bed at night with Pulmicort. Don´t know anything better yet.

April 10, 2014 at 3:21 pm
(23) michele says:

i was in thailand and had a bad broncitis attack, as i have copd i was taken to a high class hospital and immediatley put under a professor, he took my oxygen levels, did stress tests and tryedd me on ombres , i was on if for 1 week and then more tests and it showed that my oxygen levels had leveled off. i am very impressed and have been on it now for i year i also take spriva first then ombres. I live in Australia and have no problem getting it. I was not offered this by my doctor of 10 years and i did not know about it until thailand i guess doctors just keep to the same medications that they know, in all countries of the world.

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