LAMA/LABA combination bronchodilator (long-acting muscarinic antagonist / long-acting beta-2 agonist) Pregnancy: Avoid unless clearly necessary — limited data; LAMA and LABA components.

Umeclidinium / Vilanterol (Anoro Ellipta)

Brand names: Anoro Ellipta (55 mcg umeclidinium / 22 mcg vilanterol per inhalation)

Adult dose

Dose: One inhalation (55 mcg umeclidinium / 22 mcg vilanterol) once daily

Route: Inhaled (Ellipta dry powder inhaler)

Frequency: Once daily (at same time each day)

Max: One inhalation per day

COPD maintenance: dual bronchodilator combining LAMA (umeclidinium) + LABA (vilanterol) in a single once-daily inhaler. GOLD guidelines: LAMA/LABA preferred over either alone in symptomatic COPD (mMRC ≥2 or CAT ≥10). No ICS component — add Relvar Ellipta (FF/VI) or triple therapy (Trelegy Ellipta) if ICS needed. Do not use with tiotropium or other LAMAs.

Paediatric dose

Route: N/A

Frequency: N/A

Max: Not licensed in children

Not established in paediatric patients — COPD is extremely rare in children.

Dose adjustments

Renal

No dose adjustment required in mild-moderate renal impairment.

Hepatic

No dose adjustment required in mild-moderate hepatic impairment. Use with caution in severe impairment.

Clinical pearls

GOLD 2024: dual LAMA/LABA (e.g., Anoro Ellipta) is first-line for symptomatic COPD (Group B/E) — superior to LAMA alone for FEV₁ improvement and exacerbation reduction (FLAME trial)
Once-daily Ellipta device: single-dose blister strip — simple to use; improved adherence vs BD inhalers. Confirm correct technique (slow, deep inhalation)
FLAME trial: umeclidinium/vilanterol (Anoro) reduces exacerbations by 11% vs tiotropium alone in GOLD Group B/E COPD
No ICS component: appropriate for COPD without eosinophilic features (eosinophils <100 cells/mcL); if eosinophilia or frequent exacerbations, step up to Trelegy Ellipta (FFVIUMEC triple therapy)
Differentiation: Anoro (LAMA/LABA, no ICS) vs Trelegy (ICS/LAMA/LABA) — prescribe based on exacerbation risk and eosinophil count

Contraindications

Asthma (not licensed for asthma without ICS)
Severe cardiovascular disease (relative — tachyarrhythmia risk from vilanterol)
Hypersensitivity to umeclidinium, vilanterol, or lactose/milk proteins

Side effects

Dry mouth (LAMA component)
Urinary retention (especially elderly males)
Tachycardia and palpitations (LABA component)
Nasopharyngitis
Upper respiratory tract infection
Constipation

Interactions

Other LAMAs (tiotropium, aclidinium) — do not combine
QT-prolonging drugs — additive risk with vilanterol (LABA)
Strong CYP3A4 inhibitors (ketoconazole) — increase vilanterol exposure; monitor for cardiovascular effects

Monitoring

FEV₁ and CAT/mMRC score
Exacerbation frequency
HR and symptoms of urinary retention
Inhaler technique

Reference: BNFc; BNF; GOLD COPD Guidelines 2024; FLAME Trial (Wedzicha et al, NEJM 2016); NICE NG115 COPD. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways