Breztri Aerosphere is a triple-combination inhaler used to treat COPD, and its most common side effects are respiratory infections, oral thrush, voice changes, and muscle spasms. Most people tolerate it well, but because it combines three active ingredients, each one brings its own set of potential effects worth knowing about.
Breztri contains a steroid that reduces airway inflammation, a long-acting muscarinic antagonist (LAMA) that relaxes the muscles around your airways, and a long-acting beta agonist (LABA) that keeps airways open for extended periods. Side effects can come from any of these three components, so the list is broader than what you’d see with a single-ingredient inhaler.
Common Side Effects
In a 52-week clinical trial of over 2,100 people taking Breztri, the side effects that showed up most often were upper respiratory tract infections, pneumonia, bronchitis, cough, sinusitis, and influenza. These respiratory issues occurred in 1% to 10% of users. Shortness of breath also appeared in that range, which can feel counterintuitive when you’re taking a medication meant to help you breathe.
Oral thrush (a yeast infection in the mouth) affected about 3% of people on Breztri in the same trial. That’s roughly triple the rate seen in people using an inhaler without the steroid component, which confirms the steroid is the culprit. Voice hoarseness hit about 3.3% of users in a separate 24-week trial, and muscle spasms occurred at the same rate.
How to Reduce Oral Thrush and Voice Problems
The steroid in Breztri can settle on the tissues in your mouth and throat, creating conditions for yeast to grow and irritating your vocal cords. There’s a simple fix: rinse your mouth with water after every dose and spit it out. Don’t swallow. This one habit significantly cuts the risk of both thrush and hoarseness. If you notice white patches on your tongue or inner cheeks, or your voice stays raspy, let your prescriber know.
Pneumonia Risk
Inhaled steroids are known to slightly raise pneumonia risk in people with COPD, and Breztri is no exception. In the two major clinical trials (called ETHOS and KRONOS), pneumonia rates for Breztri users ranged from about 1.6% to 2.8% in the longer trial and 0% to 1.3% in the shorter one. That’s a modest increase, but COPD itself already makes you more vulnerable to lung infections. Watch for worsening cough, fever, increased mucus production, or unusual difficulty breathing, as these could signal pneumonia rather than a routine flare-up.
Heart-Related Effects
Two of Breztri’s three ingredients can affect your cardiovascular system. The LABA component stimulates receptors that also exist in heart tissue, and the LAMA component blocks signals that help regulate heart rhythm. Together, they can occasionally cause a fast or irregular heartbeat, palpitations, dizziness, or a rise in blood pressure.
These effects are uncommon at the doses delivered through an inhaler, but they matter more if you already have heart disease, a history of irregular heart rhythms, or if you take other medications that affect heart rhythm or blood pressure. If you notice your heart racing, pounding in an unusual pattern, or you feel lightheaded after using Breztri, that’s worth reporting promptly.
Urinary and Eye Problems
The LAMA component works by blocking a chemical messenger called acetylcholine, which relaxes airway muscles but can also affect other parts of the body that rely on the same messenger. Two areas to be aware of are the bladder and the eyes.
If you have an enlarged prostate or a history of bladder problems, Breztri can worsen urinary retention. Signs include difficulty starting urination, a weak stream, or pain when urinating. In people with narrow-angle glaucoma or a predisposition to it, the medication can trigger or worsen an acute episode. Symptoms of this include sudden eye pain, blurred vision, seeing halos or colored rings around lights, and red eyes. This is a medical emergency that requires immediate attention.
Long-Term Steroid Concerns
Breztri’s steroid component is delivered directly to the lungs at a relatively low dose, so systemic effects are far less dramatic than what you’d see with oral steroids. Still, over months and years of daily use, small amounts do get absorbed into your bloodstream. The FDA label carries warnings about potential effects on bone mineral density, which could contribute to thinning bones over time. There’s also a theoretical risk of adrenal suppression, where your body’s natural stress-hormone production slows because it’s receiving a steroid from an external source. In practice, these effects are uncommon at inhaled doses but become more relevant if you’re also using other steroid medications or have been on inhaled steroids for many years.
Rare but Serious Reactions
Paradoxical bronchospasm is a rare reaction where the inhaler causes your airways to tighten instead of relax, making breathing suddenly worse right after a dose. If this happens, stop using Breztri and seek immediate help. Severe allergic reactions, including swelling of the face, mouth, or throat, are also possible but very uncommon.
A large comparative study published in The BMJ found that all-cause mortality was essentially the same between different triple-inhaler therapies, with no meaningful difference in death rates. That’s reassuring context: while the list of potential side effects is long, serious outcomes are rare, and the medication’s benefit in reducing COPD flare-ups is well established in people who need triple therapy.