Triohale Inhaler
✅ Comprehensive symptom control
✅ Enhanced lung function
✅ Reduced exacerbation risk
✅ Improved quality of life
Contains Tiotropium Bromide, Formoterol Fumarate, and Ciclesonide
✓ Medically reviewed by Morgan Ellis — Pharmacy Researcher · 8 years experience · Last reviewed: May 2026
⚡ Quick Answer — What is Triohale Inhaler?
Triohale Inhaler is a triple-therapy inhaler for severe COPD and difficult asthma, combining three molecules in one device: tiotropium (LAMA), formoterol (LABA), and ciclesonide (ICS). Triple therapy targets all three modifiable mechanisms of obstructive airways disease: parasympathetic tone, smooth-muscle β2 deficiency, and airway inflammation. Used as twice-daily maintenance in COPD with frequent exacerbations. Each inhaler delivers tiotropium 9 mcg + formoterol 6 mcg + ciclesonide 200 mcg per actuation, manufactured by Cipla at WHO-GMP certified facilities.
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What Is Triohale Inhaler?
Triohale Inhaler is one of the few three-in-one fixed-dose triple-therapy inhalers available in India. Major international triple combinations include Trelegy Ellipta (fluticasone furoate + umeclidinium + vilanterol; GSK), Trimbow (beclomethasone + formoterol + glycopyrronium; Chiesi), and Breztri Aerosphere (budesonide + glycopyrrolate + formoterol; AstraZeneca). Triohale Inhaler is conceptually similar — a single twice-daily inhaler delivering all three mechanism classes.
How Does Triohale Inhaler Work?
- Tiotropium (LAMA) — blocks M3 muscarinic receptors, relaxing parasympathetic airway tone for 24 hours.
- Formoterol (LABA) — activates β2 receptors for rapid (1–3 min) and sustained (12 h) bronchodilation.
- Ciclesonide (ICS) — a prodrug activated by lung esterases; suppresses airway inflammation. The prodrug design minimises oropharyngeal candidiasis seen with older ICS.
- Combined: reduces exacerbations more than dual therapy in COPD with frequent exacerbations and elevated blood eosinophils (≥100–300/µL), per IMPACT, ETHOS, KRONOS, TRIBUTE landmark trials.
Uses and Indications
- Severe COPD with frequent exacerbations on LAMA-LABA dual therapy (GOLD group E)
- COPD with elevated blood eosinophils (≥100/µL) — eosinophilic COPD
- Severe asthma (Step 5 GINA) not controlled by ICS-LABA at high dose
- Asthma-COPD overlap (ACOS) with frequent exacerbations
Triohale Inhaler Dosage
| Patient | Dose | Frequency |
|---|---|---|
| Adults — severe COPD | 2 inhalations | Twice daily |
| Adults — severe asthma | 2 inhalations | Twice daily |
How to Use Triohale Inhaler Properly
- Shake the inhaler well; remove the cap.
- Breathe out fully away from the device.
- Seal lips around the mouthpiece.
- Press the canister at the start of a slow deep breath (3–5 seconds).
- Hold breath 10 seconds, then breathe out gently.
- Wait 30 seconds before second puff if needed.
- For ICS-containing combinations: rinse mouth, gargle, and spit out.
- Use a spacer for children, the elderly, and during acute illness.
Side Effects of Triohale Inhaler
Common:
- Dry mouth (anticholinergic)
- Mild tremor or palpitations (β2)
- Mild oral thrush, hoarseness (ICS — minimised by ciclesonide prodrug design and oral rinsing)
- Throat irritation, mild cough on inhalation
- Headache, sinusitis
Less common:
- Constipation, urinary hesitancy
- Acute angle-closure glaucoma (rare; care with mist near eyes)
- Hypokalaemia at high doses (with diuretics, theophylline, oral steroids)
- Pneumonia (slight ICS-related increase in COPD)
- Atrial fibrillation in susceptible older patients
Serious — stop and seek help:
- Severe allergic reaction / anaphylaxis
- Paradoxical bronchospasm
- Acute eye pain, red eye, halos (glaucoma — emergency)
- Acute urinary retention
- Pneumonia signs in COPD users (fever, productive cough, breathlessness change)
Warnings and Precautions
- {$brand} is a controller, not a reliever. Keep a SABA (Asthalin, Levolin) for acute attacks.
- Triple therapy is for selected COPD patients — those with frequent exacerbations on LAMA-LABA, especially with elevated blood eosinophils. Not first-line for newly diagnosed COPD.
- Pneumonia risk: ICS in COPD slightly raises pneumonia risk — ensure ICS adds value (eosinophilic phenotype, frequent exacerbations).
- Glaucoma & prostatism: caution with anticholinergic component.
- Cardiovascular disease: use cautiously with arrhythmias, severe coronary disease.
- Rinse mouth after every dose to minimise oral thrush and hoarseness.
- Pregnancy: limited data on triple therapy — discuss benefit/risk with prescriber.
Contraindications
- Hypersensitivity to tiotropium, formoterol, ciclesonide, atropine derivatives, or excipients
- Severe lactose / milk-protein hypersensitivity (DPI)
- Untreated active fungal, bacterial, mycobacterial, or viral respiratory infection
- Acute glaucoma — relative
- Severe prostatic obstruction — relative
Drug Interactions
| Interacting drug | Effect | What to do |
|---|---|---|
| Strong CYP3A4 inhibitors (ritonavir, ketoconazole, itraconazole, clarithromycin) | Increase systemic ICS exposure → adrenal suppression / Cushing risk | Avoid prolonged co-use; monitor cortisol if essential |
| Other inhaled or systemic corticosteroids | Additive HPA-axis suppression | Use lowest effective dose; monitor for systemic steroid effects |
| Live vaccines | Reduced immune response if high-dose ICS | Inactivated vaccines preferred during high-dose use |
Storage
- Store below 25°C, protected from direct sunlight and heat.
- Do not refrigerate. Do not freeze.
- Do not puncture the canister; even an empty canister can explode if heated.
- Keep out of reach of children. Use within the expiry date printed on the canister.
Related Alternatives on MedsBase
- Foracort Inhaler — budesonide + formoterol ICS-LABA
- Seretide Accuhaler — fluticasone + salmeterol ICS-LABA
- Budecort Inhaler — budesonide ICS preventer
- Duova Inhaler — tiotropium + formoterol LAMA-LABA combo
- Triohale Inhaler — tiotropium + formoterol + ciclesonide triple
Frequently Asked Questions
How is Triohale Inhaler different from Triohale Rotacaps?
Same three molecules, different device. Inhaler = pressurised aerosol with spacer compatibility. Rotacaps = dry powder, needs fast forceful inhalation. Choose based on inspiratory ability.
Is the inhaler version stronger than rotacaps?
No — total daily dose is similar. The inhaler delivers half the per-dose strength but is taken as 2 puffs vs 1 capsule.
Can I use a spacer with Triohale Inhaler?
Yes — strongly recommended, especially for ICS-containing inhalers. A spacer increases lung delivery and reduces oropharyngeal deposition.
When should I switch from ICS-LABA to triple?
For COPD: frequent exacerbations on LAMA-LABA dual therapy, especially with blood eosinophils ≥100/µL. For severe asthma: uncontrolled on high-dose ICS-LABA at Step 5 GINA.
How fast does Triohale work?
Formoterol begins in 1–3 min. Tiotropium peaks at 1–3 h. Ciclesonide preventer effect builds over 1–2 weeks.
Is Triohale safe in pregnancy?
Limited data. Budesonide-based ICS-LABA (Foracort) is the better-studied alternative if a switch is feasible.
Why dry mouth?
Anticholinergic effect from tiotropium.
How long does an inhaler canister last?
120 actuations = 30 days at 2 puffs twice daily. Track usage.
Should I rinse my mouth after Triohale?
Yes — even though ciclesonide is a prodrug with lower thrush risk, oral rinsing is still recommended after ICS-containing inhalers.
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| Strength | 200 + 6 + 9 mcg |
|---|---|
| Quantity | 1 Inhaler/s, 2 Inhaler/s, 3 Inhaler/s |
| Pharma Form | Inhaler/s |
| Manufacturer | Cipla Inc |
| Treatment | Asthma, Chronic obstructive pulmonary disorder (COPD) |
| Generic Brand | Tiotropium + Formoterol + Ciclesonide |
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