Sequadra Inhaler – Review of the latest dual bronchodilation therapy for COPD

Sequadra Inhaler – Review of the latest dual bronchodilation therapy for COPD

By Arpita Mukherjee

According to crude estimates more than 30 million people in India are suffering from chronic obstructive pulmonary disease (COPD). While smoking is the major cause of COPD, especially among men, exposure to environmental pollutants is responsible for the rising incidence of COPD among people of both the genders. Among the different treatment options, inhalers are considered superior alternative to oral medications. Not only are inhalers more effective than most of the oral drugs. Furthermore, because of the targeted treatment, they entail fewer side effects.


Unfortunately, despite doctors' recommendation, a significant number of COPD patients in India are reluctant to use inhalers. Usage of inhalers in public is associated with social stigma. Moreover, a number of people believe that inhalers are addictive. These misconceptions have emerged as major obstacles in COPD treatment. Nevertheless, drug makers are arriving with new and more effective inhalers. The latest product launched in India is Sequadra Inhaler, developed by Novartis Healthcare.

Composition: Sequadra inhaler is a combined indacaterol and glycopyrronium bromide therapy. It is a novel inhaler that provides two different types of bronchodilators in a single device. It is a revolutionary therapy as for the first time you have a once-daily inhaler that offers the benefits of long acting beta2-adrenergic agonist (LABA) as well as a long acting muscarinic antagonist (LAMA).

Benefits: There are a number of advantages of the new indacaterol and glycopyrronium combination therapy that you do not get from the current treatments with tiotropium bromide inhaler, glycopyrronium bromide inhaler or the salmeterol and fluticasone combination therapy.

Ease of Treatment

Earlier indacaterol and glycopyrronium bromide were separately used as once-daily inhalers for managing COPD exacerbation. Although this is still the preferred choice for COPD treatment, however, in case of patients who do not respond satisfactorily to mono-therapy, the indacaterol and glycopyrronium bromide combination, comprising of 110 mcg indacaterol and 50 mcg of glycopyrronium is a more effective alternative. Just as the mono-therapy with the individual constituents of Sequadra, the combination therapy too requires once a day administration. The alternative combination therapy with salmeterol and fluticasone, on the other hand, is a twice-daily therapy. Hence, the ease of treatment is a prominent benefit of the new inhaler.

More Effective

Extensive clinical trials carried out in 76 countries offer hope that compared with the twice a day salmeterol/fluticasone combination therapy for controlling exacerbation in patients suffering from moderate to severe COPD, the once-daily indacaterol/ glycopyrronium therapy could bring down the annual incidence of COPD exacerbation by almost 31%. Hence, Sequadra inhaler promises greater improvement in the quality of life of COPD patients. Clinical studies further suggest that compared with the tiotropium 18 mcg monotherapy and salmeterol (50mcg)/ fluticasone (500 mcg) combination therapy, Sequadra causes significant improvement in the lung function two hours after administration.


The only downside of Sequadra inhaler usage is its high price. Priced at Rs 2479 per packet, Sequadra inhaler is a costly treatment option in a country where a sizeable number of COPD patients belong to the low-income group. On the other hand, the price of a salmeterol/fluticasone inhaler is around Rs 280.