Umeclidinium / Vilanterol (Anoro Ellipta)

How it works

Umeclidinium antagonises airway muscarinic receptors to reduce bronchoconstriction while vilanterol stimulates beta-2 adrenoceptors to relax smooth muscle, providing dual sustained bronchodilatation.

Prescribing in practice

• Avoid the umeclidinium component in narrow-angle glaucoma and use cautiously with bladder-outflow obstruction or prostatic enlargement owing to antimuscarinic effects.
• The vilanterol LABA needs caution in cardiovascular disease, arrhythmias and hyperthyroidism, with additive hypokalaemia risk alongside corticosteroids and diuretics.
• Supply a separate short-acting bronchodilator, as the Ellipta device is for regular maintenance and not for acute symptom relief.

Monitoring

Monitor inhaler technique, breathlessness, exacerbation rate and antimuscarinic or cardiovascular tolerability at review.

Counselling the patient

• Use one inhalation at the same time daily for prevention; it will not help a sudden attack.
• Report eye pain, blurred vision or trouble passing urine.

Evidence & guidelines

Anoro Ellipta is supported by COPD trials and NICE guidance demonstrating greater lung-function and symptom benefit than single long-acting bronchodilators.