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Triple Therapy ICS/LAMA/LABA — COPD Pregnancy: Not applicable (COPD — adult condition); if pregnant with COPD, seek respiratory specialist input

Fluticasone Furoate / Umeclidinium / Vilanterol

Brand names: Trelegy Ellipta

Adult dose

Dose: 92/55/22 mcg once daily (1 inhalation)
Route: Inhaled (Ellipta DPI)
Frequency: Once daily
Max: 1 inhalation once daily
Triple inhaler for COPD: ICS (fluticasone furoate) + LAMA (umeclidinium) + LABA (vilanterol). Indicated for maintenance treatment of COPD in adults who are not adequately controlled on dual bronchodilator or ICS/LABA therapy. Simplifies regimen from multiple inhalers to single once-daily device.

Paediatric dose

Dose: Not applicable mcg/kg
Route: Inhaled
Frequency: Once daily
Max: Not applicable
Not licensed in children — COPD is an adult condition

Dose adjustments

Renal

No dose adjustment required

Hepatic

Use with caution in severe hepatic impairment

Paediatric weight-based calculator

Not licensed in children — COPD is an adult condition

Clinical pearls

  • IMPACT trial: Trelegy significantly reduced moderate-to-severe exacerbations vs dual LAMA/LABA (umeclidinium/vilanterol) and ICS/LABA (fluticasone/vilanterol) in patients with ≥1 exacerbation in prior year
  • ICS in COPD: increases pneumonia risk — IMPACT trial: 8% vs 6% with dual bronchodilator; reserve ICS for COPD with eosinophilia ≥100 cells/μL or frequent exacerbations
  • NICE NG115: offer triple therapy (ICS/LAMA/LABA) in COPD if FEV1 <50% predicted AND ≥2 exacerbations/year despite dual LABA/LAMA
  • Single device advantage: adherence significantly better than 2 separate inhalers; reduces prescription errors and inhaler confusion
  • Pneumonia risk: ICS in COPD increases pneumonia risk — annual influenza vaccine and pneumococcal vaccination essential
  • Blood eosinophil count guides ICS use in COPD: ≥300 cells/μL — likely to benefit; <100 cells/μL — less likely to benefit and higher infection risk

Contraindications

  • Asthma as sole indication (not licensed for asthma)
  • Acute COPD exacerbation
  • Hypersensitivity to any component

Side effects

  • Pneumonia (ICS component — significant in COPD; NNH ~25 over 1 year)
  • Oropharyngeal candidiasis
  • Dysphonia
  • Constipation (LAMA)
  • Urinary retention (LAMA — angle-closure glaucoma risk)
  • Tachycardia (LABA)

Interactions

  • CYP3A4 inhibitors — increased ICS systemic exposure
  • Beta-blockers — antagonise LABA
  • Anticholinergics — additive anticholinergic effects (urinary retention, constipation)

Monitoring

  • Spirometry (FEV1) annually
  • Exacerbation frequency
  • Pneumonia surveillance
  • Inhaler technique
  • Blood eosinophil count (guide ICS decision)

Reference: BNFc; BNF 90; IMPACT Trial (Lipson et al. NEJM 2018); NICE NG115 (COPD 2019); GOLD 2024; SPC Trelegy Ellipta. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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