Fluticasone with vilanterol

How it works

Fluticasone furoate suppresses airway inflammation via glucocorticoid receptor activation, while vilanterol provides prolonged bronchodilation by stimulating airway beta2 adrenoceptors.

Prescribing in practice

• In asthma the long-acting beta2 agonist must always be combined with the inhaled corticosteroid and never used alone, and this inhaler is not for relieving acute symptoms.
• Inhaled corticosteroid exposure increases pneumonia risk in COPD and can cause oral candidiasis and hoarseness.
• Beta2 agonist effects include tremor, palpitations and hypokalaemia, with caution in cardiovascular disease.

Monitoring

Monitor disease control and inhaler technique, watch for pneumonia in COPD, and review growth in children on long-term inhaled corticosteroid.

Counselling the patient

• Use once daily as a preventer, not to treat sudden attacks.
• Rinse the mouth after each dose to limit thrush and hoarseness.
• Always keep a reliever inhaler available and report deterioration.

Evidence & guidelines

An established once-daily inhaled corticosteroid/long-acting beta2 agonist combination supported by asthma and COPD trial evidence and reflected in UK respiratory guidance.