Beclometasone / Formoterol / Glycopyrronium

How it works

Beclometasone dampens airway inflammation, formoterol relaxes bronchial smooth muscle via beta-2 receptors, and glycopyrronium produces additional bronchodilation by blocking muscarinic receptors.

Prescribing in practice

• Most important: reserve triple therapy for patients inadequately controlled on dual therapy and review pneumonia risk, as the inhaled corticosteroid component increases pneumonia incidence in COPD.
• Use the antimuscarinic with caution in symptomatic prostatic hyperplasia, bladder-outflow obstruction and narrow-angle glaucoma.
• Ensure the patient is not also taking a separate LABA or LAMA to avoid duplicate long-acting bronchodilator exposure.

Monitoring

Monitor COPD control and exacerbations, watch for pneumonia, and review cardiovascular symptoms and anticholinergic side effects.

Counselling the patient

• Rinse the mouth after each dose to reduce oral thrush.
• Report worsening breathlessness with fever or new urinary difficulty, and use it every day as prescribed.

Evidence & guidelines

Single-inhaler triple therapy is supported by trials showing reduced exacerbations versus dual therapy in COPD and is reflected in GOLD and NICE guidance.