Formoterol with glycopyrronium and budesonide

How it works

Formoterol stimulates beta2 adrenoceptors and glycopyrronium blocks muscarinic receptors to provide complementary bronchodilation, while budesonide reduces airway inflammation through glucocorticoid receptor activation.

Prescribing in practice

• It is a regular maintenance inhaler only and must never be used to relieve acute breathlessness, which requires a separate short-acting reliever.
• The inhaled corticosteroid increases pneumonia risk in COPD, and the antimuscarinic component requires caution in closed-angle glaucoma and bladder outflow obstruction.
• Avoid concurrent use of other long-acting bronchodilators or inhaled corticosteroids to prevent duplication and additive effects, and counsel on correct priming and use of the pressurised device.

Monitoring

Monitor symptom control, inhaler technique and adherence, with attention to pneumonia in COPD, oral candidiasis and antimuscarinic adverse effects.

Counselling the patient

• Use regularly twice a day; it is not for sudden symptoms.
• Rinse the mouth after inhaling to reduce thrush and hoarseness.
• Report fever, worsening breathlessness, eye pain or urinary difficulty.

Evidence & guidelines

Fixed triple therapy in a single inhaler is supported by COPD trials showing reduced exacerbations and mortality benefit versus dual therapy and is reflected in NICE COPD guidance.