Fluticasone Furoate / Umeclidinium / Vilanterol

How it works

Fluticasone furoate provides anti-inflammatory corticosteroid activity, umeclidinium produces sustained bronchodilation by blocking muscarinic receptors, and vilanterol relaxes airway smooth muscle via beta2 adrenoceptor stimulation.

Prescribing in practice

• It is a maintenance treatment only and must never be used to relieve acute breathlessness or an exacerbation, for which a separate short-acting reliever is needed.
• Inhaled corticosteroid exposure raises the risk of pneumonia in COPD, and antimuscarinic effects warrant caution in glaucoma and bladder outflow obstruction.
• It should not be combined with other long-acting bronchodilators or inhaled corticosteroids to avoid therapeutic duplication and additive effects.

Monitoring

Review inhaler technique and symptom control regularly, watching for pneumonia signs in COPD, oral candidiasis and antimuscarinic effects.

Counselling the patient

• Use every day as a preventer, not for sudden symptoms.
• Rinse the mouth after inhaling to reduce thrush and hoarseness.
• Report worsening breathlessness, fever or new visual or urinary symptoms.

Evidence & guidelines

Once-daily single-inhaler triple therapy is supported by major COPD trials showing reduced exacerbations versus dual therapy and is recommended in NICE COPD guidance for appropriate patients.