From the Guidelines
Fluticasone dosing for COPD should be 250-500 mcg twice daily, as part of a combination therapy with a long-acting bronchodilator, to reduce the risk of acute exacerbations and improve health-related quality of life. When considering the management of COPD, the American College of Chest Physicians and Canadian Thoracic Society guideline 1 recommends maintenance combination inhaled corticosteroid/long-acting b2-agonist therapy to prevent acute exacerbations of COPD. Some key points to consider when prescribing fluticasone for COPD include:
- The dose of fluticasone propionate (Flovent) is often 250-500 mcg twice daily for moderate to severe COPD
- Fluticasone furoate (part of Breo Ellipta) is given as 100 mcg once daily
- Combination therapy with a long-acting bronchodilator, such as salmeterol (Advair) or vilanterol (Breo Ellipta), is preferred over monotherapy
- Patients should rinse their mouth after each use to prevent oral thrush, a common side effect
- ICS therapy in COPD is generally reserved for patients with frequent exacerbations or those with features of asthma-COPD overlap, due to risks including pneumonia, particularly in older patients with COPD, as noted in the guideline 1. The guideline places high value on reducing the risk of acute exacerbations of COPD, together with improved health-related quality of life, reduced dyspnea, less rescue medication use, and improved lung function, while acknowledging the risks and consequences of oral candidiasis, upper respiratory tract infections, and pneumonia 1.
From the FDA Drug Label
2.1 Recommended Dosage for Maintenance Treatment of Chronic Obstructive Pulmonary Disease The recommended dosage of BREO ELLIPTA 100/25 mcg (containing fluticasone furoate 100 mcg and vilanterol 25 mcg) is 1 actuation once daily by oral inhalation.
The recommended fluticasone dosing for COPD is 100 mcg once daily by oral inhalation, as part of BREO ELLIPTA 100/25 mcg 2.
From the Research
Fluticasone Dosing for COPD
- The dosing of fluticasone for COPD is typically considered as part of a combination therapy, including long-acting muscarinic receptor antagonists (LAMA) and long-acting β2-adrenoceptor agonists (LABA) 3.
- A study published in 2013 found that fluticasone furoate (FF)/vilanterol (VI) at a strength of 100/25 μg significantly improved weighted mean FEV1 and trough FEV1 compared to placebo in patients with moderate-to-severe COPD 4.
- The same study found that FF/VI 50/25 μg also improved lung function, although to a lesser extent than FF/VI 100/25 μg 4.
- Another study published in 2019 compared the efficacy and safety of different inhaled corticosteroid (ICS) plus long-acting β2-agonist (LABA) combinations, including fluticasone/vilanterol, and found that the effects of budesonide/formoterol on reducing exacerbations and improving quality of life may be similar to, or more marked than, those of other LABA/ICS combinations in COPD 5.
- A 2021 review of triple combination therapy for COPD found that the addition of an ICS to LABA/LAMA combination is recommended for frequently exacerbating patients with high levels of blood eosinophils, and that fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) is one of the approved triple therapies for the treatment of COPD 6.
Combination Therapies
- Combination therapies, including fluticasone, are often used to treat COPD, and the choice of therapy depends on the severity of the disease and the patient's response to treatment 3, 4, 6.
- The use of triple combination therapy, including an ICS, LAMA, and LABA, is recommended for patients with frequent exacerbations and high blood eosinophil counts 6, 7.
- However, the use of ICS in COPD treatment is not without controversy, and some studies suggest that ICS may be overused in clinical practice 7.