Is Breo (fluticasone furoate/vilanterol) administered once or twice daily for Chronic Obstructive Pulmonary Disease (COPD)?

Breo (Fluticasone Furoate/Vilanterol) Dosing for COPD

Breo (fluticasone furoate/vilanterol) is administered once daily for the treatment of Chronic Obstructive Pulmonary Disease (COPD). 1

Dosing Details

• 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. 1
• Breo should be used at the same time every day and should not be used more than once every 24 hours. 1
• More frequent administration or a greater number of inhalations is not recommended as patients may experience more adverse effects with higher doses. 1

Evidence Supporting Once-Daily Dosing

The once-daily dosing of Breo is supported by several key pieces of evidence:

1. FDA Approval: The FDA label explicitly states that Breo Ellipta is indicated for maintenance treatment of COPD with a dosing schedule of one actuation once daily. 1

2. Pharmacological Properties:

   • Vilanterol has a highly selective action on β2-adrenoreceptors and provides a rapid onset with prolonged duration of action, allowing for once-daily dosing. 2
   • Fluticasone furoate has enhanced affinity for the glucocorticoid receptor compared with other inhaled corticosteroids and demonstrates longer lung retention than fluticasone propionate. 2

3. Clinical Efficacy: In phase 3 trials, once-daily fluticasone furoate/vilanterol 100/25 μg improved pulmonary function more effectively than placebo and fluticasone furoate alone, while reducing exacerbation rates more effectively than vilanterol alone. 2, 3

Clinical Considerations

• If shortness of breath occurs between doses, an inhaled short-acting beta2-agonist (rescue medicine, e.g., albuterol) should be used for immediate relief. 1
• After inhalation, patients should rinse their mouth with water without swallowing to help reduce the risk of oropharyngeal candidiasis. 1
• The American College of Chest Physicians and Canadian Thoracic Society guidelines note that Breo (fluticasone furoate/vilanterol) is one of the once-daily long-acting β-agonist/inhaled corticosteroid formulations that has been shown to improve lung function and reduce exacerbations. 4

Potential Benefits of Once-Daily Dosing

• The once-daily administration of Breo may improve treatment adherence in some patients compared to medications requiring multiple daily doses. 2
• Real-world effectiveness data from the ELLITHE study showed that once-daily single-inhaler therapy resulted in significant and clinically relevant improvements in COPD Assessment Test scores and FEV1 in COPD patients. 5

Safety Considerations

• As with all inhaled corticosteroids, long-term use of Breo is associated with an increased risk of pneumonia. 2, 3
• The incidence of adverse events with Breo is generally similar to that associated with the individual components or comparable to other LABA/ICS combinations. 2

In conclusion, Breo (fluticasone furoate/vilanterol) is definitively administered once daily for COPD management, with clinical evidence supporting this dosing regimen for optimal efficacy and patient adherence.