Beclometasone with formoterol and glycopyrronium

How it works

It pairs anti-inflammatory glucocorticoid action with two complementary bronchodilator mechanisms — beta-2 agonism and muscarinic antagonism — to maximise airflow and reduce exacerbations.

Prescribing in practice

• Most important: reserve for patients inadequately controlled on dual therapy and counsel on the increased pneumonia risk associated with the inhaled corticosteroid component in COPD.
• Apply antimuscarinic cautions: avoid or use carefully in narrow-angle glaucoma, prostatic hyperplasia and bladder-outflow obstruction.
• Confirm the patient is not concurrently using a separate LABA or LAMA inhaler.

Monitoring

Monitor COPD or asthma control and exacerbations, watch for pneumonia and anticholinergic effects, and review cardiovascular tolerance.

Counselling the patient

• Rinse the mouth after each dose to reduce oral thrush.
• Report worsening breathlessness with fever, eye pain, or difficulty passing urine, and use it daily as prescribed.

Evidence & guidelines

Single-inhaler triple therapy reduces exacerbations versus dual therapy in COPD trials and is reflected in GOLD and NICE guidance.