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ICS/LABA — Asthma / COPD Pregnancy: Continue if already established — poorly controlled asthma is more harmful; switch to well-evidenced ICS/LABA if needed

Fluticasone Furoate / Vilanterol

Brand names: Relvar Ellipta

Adult dose

Dose: 92/22 mcg once daily (asthma and COPD) or 184/22 mcg once daily (asthma — if higher ICS dose needed)
Route: Inhaled (Ellipta DPI — dry powder inhaler)
Frequency: Once daily
Max: 184/22 mcg once daily
Fluticasone furoate (ICS) + vilanterol (LABA) in once-daily Ellipta device. Indicated for asthma (as step-up from ICS alone) and COPD (symptomatic on LAMA alone). Once-daily dosing improves adherence. NICE recommends once-daily ICS/LABA for COPD when adding LABA to ICS or LAMA to ICS.

Paediatric dose

Dose: 92/22 mcg once daily mcg/kg
Route: Inhaled DPI
Frequency: Once daily
Max: 92/22 mcg once daily
BNFc: licensed from 12 years for asthma (92/22 mcg strength only)

Dose adjustments

Renal

No dose adjustment required

Hepatic

Use with caution in severe hepatic impairment — increased systemic fluticasone exposure

Paediatric weight-based calculator

BNFc: licensed from 12 years for asthma (92/22 mcg strength only)

Clinical pearls

  • Ellipta DPI: simple one-step inhalation device — lower technique failure rate than MDI; preferred for patients who struggle with MDI coordination
  • Once-daily ICS/LABA: evidence shows non-inferior symptom control vs twice-daily equivalent — improves real-world adherence (HARMONY trials)
  • COPD: Relvar 92/22 mcg reduces exacerbations in symptomatic COPD (SUMMIT trial); add LAMA (Trelegy — triple therapy) if persistent exacerbations
  • Fluticasone furoate vs fluticasone propionate: different molecules with different receptor binding affinity and systemic absorption profile — not interchangeable
  • LABA alone (vilanterol) contraindicated in asthma — must always be combined with ICS (SMART trial: LABA monotherapy associated with increased asthma deaths)

Contraindications

  • Acute asthma attack (LABA bronchodilation too slow)
  • Monotherapy LABA in asthma (must always combine with ICS)

Side effects

  • Oropharyngeal candidiasis
  • Dysphonia
  • Nasopharyngitis
  • Upper RTI
  • Headache
  • Back pain
  • Paradoxical bronchospasm (rare)

Interactions

  • CYP3A4 inhibitors (azoles, ritonavir) — increased fluticasone systemic exposure; avoid strong inhibitors
  • Beta-blockers — antagonise vilanterol bronchodilation

Monitoring

  • Symptom control (ACQ, mMRC)
  • PEFR / spirometry
  • Inhaler technique at each review
  • Oral candidiasis

Reference: BNFc; BNF 90; BNFc; SUMMIT Trial (Vestbo et al. NEJM 2016); GINA 2024; NICE NG115 (COPD); SPC Relvar 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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