What is the recommended use and dosage of Vilanterol (long-acting beta2-adrenergic agonist) for chronic obstructive pulmonary disease (COPD) and asthma management?

Vilanterol for COPD and Asthma Management

Vilanterol is recommended at a standard dosage of 25 mcg once daily by oral inhalation for both COPD and asthma management, always in combination with an inhaled corticosteroid such as fluticasone furoate. 1, 2

Recommended Dosage and Administration

For COPD:

• Vilanterol 25 mcg combined with fluticasone furoate 100 mcg (as BREO ELLIPTA or similar combination) is administered as 1 actuation once daily 1
• The medication should be used at the same time every day to maintain consistent blood levels and therapeutic effect 2
• For symptomatic patients with FEV1 <60% predicted, long-acting β-agonists like vilanterol are strongly recommended as monotherapy or in combination with other agents 3

For Asthma:

• Adults and adolescents (12-17 years): Vilanterol 25 mcg with fluticasone furoate 100 mcg once daily 2
• For inadequate response, the fluticasone component can be increased to 200 mcg while maintaining vilanterol at 25 mcg 1
• Children (5-11 years): Vilanterol 25 mcg with fluticasone furoate 50 mcg once daily 2
• Maximum recommended dosage is 1 inhalation daily of the appropriate strength 1

Pharmacological Properties

• Vilanterol is a novel long-acting β2-agonist with inherent 24-hour activity 4
• Rapid onset of action with bronchodilation beginning as early as 5 minutes after administration 4
• Median time to 100 mL improvement in FEV1 is approximately 15 minutes 2
• Provides sustained bronchodilation over a full 24-hour period, supporting once-daily dosing 4, 5

Clinical Efficacy

In COPD:

• Vilanterol 25 mcg produces clinically relevant improvements in trough FEV1 of ≥130 mL versus placebo 5
• Provides significant 24-hour improvements in lung function parameters 5
• When combined with umeclidinium (LAMA), shows enhanced improvement in FEV1 compared to either drug alone 6
• The combination of fluticasone furoate/vilanterol has extensive clinical trial and real-world data supporting its efficacy in reducing COPD exacerbations 7

In Asthma:

• Long-acting β2-agonists like vilanterol are recommended in combination with inhaled corticosteroids for persistent asthma (phases 2-4) 3
• Should never be used as monotherapy for asthma management 3
• For patients who don't respond adequately to the 100/25 mcg dose, increasing to 200/25 mcg may provide additional asthma control 2

Safety Considerations

• Vilanterol has a safety and tolerability profile similar to placebo across doses from 3 to 50 mcg 5
• Low incidence of treatment-related adverse events in clinical trials 4
• No clinically significant effects on blood pressure, pulse rate, QTc intervals, blood glucose or potassium levels at therapeutic doses 4, 5
• After inhalation, patients should rinse their mouth with water (without swallowing) to reduce the risk of oropharyngeal candidiasis 1, 2
• More frequent administration than once daily is not recommended due to increased risk of adverse effects 2

Special Considerations

• For COPD patients with FEV1 between 60% and 80% predicted, treatment with inhaled bronchodilators may be used, but evidence of benefit is limited 3
• For rescue/immediate relief of symptoms between scheduled doses, a short-acting β2-agonist (e.g., albuterol) should be used 1, 2
• Patient preference, cost, and adverse effect profile should guide the choice between long-acting bronchodilator monotherapies 3
• Patients with asthma-COPD overlap, eosinophilia, brisk bronchodilator response, or frequent exacerbations are more likely to benefit from ICS/LABA combinations like fluticasone/vilanterol 7

Practical Implementation

• Vilanterol is only available in fixed-dose combinations with either fluticasone furoate or umeclidinium 8, 6
• The once-daily dosing regimen may improve patient compliance compared to medications requiring multiple daily doses 8
• Proper inhaler technique should be demonstrated and regularly assessed to ensure optimal drug delivery 1
• Regular monitoring of symptom control and lung function is recommended to evaluate treatment response 3