NHS Greater Glasgow & Clyde Area Drug and Therapeutics Committee
Greater Glasgow and Clyde Medicines
Medicines Update

Caution with switch to Trimbow® or Trelegy®

Launch of the two new “triple inhalers” described below has presented an opportunity to simplify inhaler regimens for some patients with COPD, while simultaneously generating substantial efficiency savings. Note that Trimbow® and Trelegy® are only licensed for COPD.

Whilst independent prescribers will apply clinical judgement in individual cases, prescribing support teams were advised to exclude the following groups of patients due to risk of destabilising symptom control:

  • Patients who do not have a diagnosis of COPD
  • Patients with a diagnosis of asthma / COPD overlap syndrome who are prescribed a high dose ICS/LABA combination inhaler. These patients are considered unsuitable for “triple inhaler” because the ICS dose of these is fixed at medium dose.
  • Patients with poorly controlled or brittle asthma (in addition to COPD) or exacerbation/deterioration in symptoms in the last three months should not be switched to “triple inhalers”. Note there is no flexibility to step ICS dose up or down.
  • Where there has been a specific direction from a respiratory consultant that the ICS/LABA inhaler should not be changed

Where a patient is under the care of a respiratory consultant, consider discussing proposed changes with the consultant prior to changing the patient’s inhaled therapies. 

(If viewing table on a mobile device switch to landscape)

Inhaler

Components

Licensed dose

Equivalent to

Trimbow®

Beclometasone dipropionate 87 micrograms, formoterol fumarate dihydrate 5 micrograms, glycopyrronium 9 micrograms

TWO puffs TWICE daily

Fostair® 100/6, TWO puffs TWICE daily

plus a LAMA inhaler

Trelegy®

Fluticasone furoate 92 micrograms, umeclidinium 55 micrograms, vilanterol 22 micrograms

ONE puff ONCE daily

Relvar Ellipta® 92/22, ONE puff ONCE daily

plus a LAMA inhaler

 

Prescribers should consult the individual Summary of Product Characteristics (available here) for detailed prescribing information on each product before prescribing.

For NHSGGC Guidance on treatment of COPD see Asthma and COPD preferred list inhaler device guide (primary and secondary care) on StaffNet.

 

High dose ICS/LABA inhaler regimes which are not suitable for change to triple inhalers:

  • Fostair® MDI or NEXThaler® 200/6, 2 puffs twice daily
  • Relvar Ellipta® 184/22, 1 puff daily
  • Duoresp Spiromax® 320/9, 2 puffs twice daily
  • Symbicort Turbohaler® 400/12, 2 puffs twice daily
  • Flutiform 250/10®, 2 puffs twice daily
  • Seretide Accuhaler 500/50®, 1 puff twice daily
  • Seretide Evohaler 250/25®, 2 puffs twice daily

Glossary

ICS: Inhaled corticosteroid

LABA: Long-acting beta agonist

LAMA: Long-acting muscarinic antagonist

 

Published 17/12/18. Medicines Update blogs are correct at the time of publication.