Fluticasone with umeclidinium and vilanterol

How it works

Fluticasone furoate reduces airway inflammation, umeclidinium provides sustained bronchodilation by antagonising muscarinic receptors, and vilanterol relaxes airway smooth muscle through beta2 adrenoceptor stimulation.

Prescribing in practice

• It is a once-daily maintenance treatment only and must never be used for acute symptom relief, which requires a separate short-acting reliever.
• The inhaled corticosteroid increases pneumonia risk in COPD, and the antimuscarinic component warrants caution in closed-angle glaucoma and bladder outflow obstruction.
• Avoid co-prescribing other long-acting bronchodilators or inhaled corticosteroids to prevent duplication and additive cardiovascular and antimuscarinic effects.

Monitoring

Monitor symptom control, inhaler technique and adherence, with vigilance for pneumonia in COPD, candidiasis, and antimuscarinic adverse effects.

Counselling the patient

• Use once every day as a preventer, not for sudden breathlessness.
• Rinse the mouth after inhaling to reduce thrush and hoarseness.
• Report fever, worsening breathlessness, eye pain or difficulty passing urine.

Evidence & guidelines

Single-inhaler triple therapy is supported by COPD outcome trials demonstrating fewer exacerbations than dual therapy and is recommended in NICE guidance for selected patients.