Triple Therapy ICS/LABA/LAMA — COPD
Pregnancy: Not applicable — COPD in pregnancy: seek specialist respiratory input
Beclometasone / Formoterol / Glycopyrronium
Brand names: Trimbow
Adult dose
Dose: 87/5/9 mcg — 2 inhalations twice daily
Route: Inhaled (MDI or NEXThaler DPI)
Frequency: Twice daily
Max: 4 inhalations daily (2 puffs twice daily)
Extra-fine particle triple therapy for COPD. Alternative to Trelegy Ellipta. Trimbow MDI or NEXThaler (breath-actuated) for patients who prefer twice-daily or MDI device. ETHOS trial and KRONOS trial support triple therapy in COPD with exacerbation history.
Paediatric dose
Dose: Not applicable mcg/kg
Route: Inhaled
Frequency: Twice daily
Max: Not applicable
Not licensed in children
Dose adjustments
Renal
No dose adjustment required
Hepatic
Use with caution in severe hepatic impairment
Paediatric weight-based calculator
Not licensed in children
Clinical pearls
- KRONOS trial: Trimbow triple therapy significantly reduced moderate/severe exacerbations vs ICS/LABA (beclometasone/formoterol) and LAMA/LABA (formoterol/glycopyrronium) in symptomatic COPD
- Extra-fine particle advantage over Trelegy: deeper small airway deposition — particularly beneficial in small airway disease (emphysematous phenotype)
- MDI option: Trimbow MDI available for patients who prefer MDI over Ellipta DPI — with spacer if needed
- Trimbow vs Trelegy: similar clinical efficacy in head-to-head data; device preference and patient familiarity guide choice
- GOLD 2024: triple ICS/LABA/LAMA recommended for GOLD group E (high symptom burden + exacerbations) or persistent exacerbations despite dual bronchodilator
- Pneumococcal and influenza vaccination mandatory for all COPD patients on ICS-containing regimens
Contraindications
- Asthma (not licensed for asthma)
- Acute exacerbation
- Hypersensitivity to any component
Side effects
- Pneumonia (ICS component)
- Oropharyngeal candidiasis
- Dysphonia
- Constipation
- Urinary retention (anticholinergic)
- Palpitations
- Tremor
Interactions
- Beta-blockers — antagonise formoterol
- CYP3A4 inhibitors — increase ICS exposure
- Other anticholinergics — additive effects
Monitoring
- FEV1 annually
- Exacerbation rate
- Blood eosinophil count
- Pneumonia surveillance
- Inhaler technique
Reference: BNFc; BNF 90; KRONOS Trial (Ferguson et al. Lancet Resp Med 2018); GOLD 2024; NICE NG115; SPC Trimbow. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators
- DAPT Score for Dual Antiplatelet Therapy Duration · Antiplatelet Therapy
- ACC/AHA Pooled Cohort Equations (ASCVD Risk) · Cardiovascular Risk
- DAPT Decision Tool (Ticagrelor vs Clopidogrel) · Antiplatelet Therapy
- Travis Criteria for Severe Ulcerative Colitis · Inflammatory Bowel Disease
- Milan Criteria vs UCSF Criteria for Liver Transplantation in HCC · Liver Transplantation
- Rome IV Diagnostic Criteria for Functional Constipation · Functional GI Disorders
Pathways
- Acute Asthma in Adults · BTS/SIGN British Guideline on Asthma 2019; NICE NG80
- Pulmonary Embolism Assessment · NICE NG158; ESC 2019 PE Guidelines
- Acute Exacerbation of COPD (AECOPD) · NICE NG115; GOLD 2024
- Spontaneous Pneumothorax (Adult) · BTS Pleural Disease 2023
- Atypical Pneumonia (Legionella / Mycoplasma / Chlamydophila) · BTS 2023; IDSA
- COPD Exacerbation Management · NICE NG115 / GOLD 2024