What is the best course of action for a patient with Chronic Obstructive Pulmonary Disease (COPD) on Trelegy (fluticasone furoate, umeclidinium, and vilanterol) experiencing wheezing?

From the Guidelines

For a COPD patient on Trelegy who is experiencing wheezing, the best immediate course of action is to use a rescue inhaler such as albuterol 2 puffs every 4-6 hours as needed, while continuing their regular Trelegy dose as prescribed. The patient should be advised to use albuterol as needed for immediate relief of wheezing symptoms. It is essential to continue the regular Trelegy dose, typically one inhalation daily, as it provides longer-term control of COPD symptoms through its three components: fluticasone (an anti-inflammatory), umeclidinium (a long-acting bronchodilator), and vilanterol (another long-acting bronchodilator) 1. If wheezing persists for more than 24-48 hours despite using the rescue inhaler, or if it's accompanied by increased shortness of breath, chest tightness, or difficulty breathing, the patient should contact their healthcare provider promptly as this may indicate a COPD exacerbation requiring additional treatment 1. Key considerations for managing COPD exacerbations include:

• Using rescue inhalers like albuterol for immediate symptom relief
• Continuing regular maintenance therapy like Trelegy
• Monitoring for signs of exacerbation that may require additional treatment, such as oral corticosteroids or antibiotics
• Adjusting treatment as needed based on the patient's response and clinical guidelines.

From the Research

Patient with COPD on Trelegy Experiencing Wheezing

• The patient is already on Trelegy, which is a combination of fluticasone furoate, umeclidinium, and vilanterol, indicating they are likely being managed for severe COPD 2, 3.
• Wheezing in a patient with COPD can be a sign of bronchospasm or an exacerbation, which may require additional treatment such as a short-acting beta-2 adrenoceptor agonist (SABA) like albuterol 4.
• The use of albuterol as a rescue medication for acute symptoms such as wheezing is supported by studies that show beta-2 agonists can provide rapid relief of bronchospasm in COPD patients 4.

Management Considerations

• For a patient on Trelegy experiencing wheezing, the first step would be to use albuterol as needed for symptom relief, as it is a recommended rescue medication for acute bronchospasm in COPD patients 4.
• If symptoms persist or worsen, reevaluation of the patient's treatment plan may be necessary, considering the addition of other therapies or adjustment of current medications 2, 3.
• Studies have shown that triple therapy with an inhaled corticosteroid, a long-acting muscarinic antagonist, and a long-acting beta-2 agonist (such as Trelegy) can improve symptoms and reduce exacerbations in patients with COPD 2, 3, 5.

Safety and Efficacy

• The safety and efficacy of Trelegy have been demonstrated in several studies, showing improvements in lung function, symptoms, and quality of life, with a good safety profile 2, 3, 6.
• The addition of albuterol for rescue use in patients on Trelegy is consistent with guidelines for the management of COPD exacerbations and acute symptoms 4.