Can a patient with Chronic Obstructive Pulmonary Disease (COPD) take Trelegy (fluticasone furoate, umeclidinium, vilanterol) and albuterol (salbutamol) for maintenance treatment?

Trelegy and Albuterol Can Be Used Together for COPD Maintenance Therapy

Yes, a patient with COPD can take Trelegy (fluticasone furoate, umeclidinium, vilanterol) as a maintenance therapy along with albuterol as a rescue medication. This combination provides both long-term disease control and as-needed symptom relief.

Understanding Trelegy in COPD Management

Trelegy is a single-inhaler triple therapy containing:

• Fluticasone furoate (inhaled corticosteroid/ICS)
• Umeclidinium (long-acting muscarinic antagonist/LAMA)
• Vilanterol (long-acting β2-agonist/LABA)

This triple therapy is indicated for:

• Maintenance treatment of moderate to severe COPD 1
• Patients who are not adequately controlled on dual therapy (either ICS/LABA or LAMA/LABA) 2
• Patients at high risk of exacerbations with moderate to high symptom burden 3

Role of Albuterol with Trelegy

Albuterol (salbutamol) serves as a short-acting β2-agonist (SABA) that can be used alongside Trelegy for:

• Immediate symptom relief during acute breathlessness 3
• Rescue therapy when needed, complementing the maintenance therapy provided by Trelegy

Evidence Supporting This Combination

The 2023 Canadian Thoracic Society guidelines strongly recommend LAMA/LABA/ICS triple therapy for patients with:

• High exacerbation risk (≥2 moderate exacerbations or ≥1 severe exacerbation in the past year)
• Moderate to high symptom burden (CAT ≥10 or mMRC ≥2)
• Impaired lung function (FEV1 <80% predicted) 3, 4

Triple therapy has demonstrated:

• Lower annual rates of moderate or severe exacerbations compared to dual therapies 3
• Improved lung function and health-related quality of life 3
• Potential mortality benefits in high-risk patients 3

Important Considerations

• Pneumonia risk: Triple therapy containing ICS carries an increased risk of pneumonia, but the benefit-risk ratio is favorable with a number needed to treat of 4 to prevent one exacerbation versus number needed to harm of 33 to cause one pneumonia 3, 4

• Dosing schedule: Trelegy is administered once daily, while albuterol is used as needed for symptom relief 5, 6

• Not for acute symptoms: Trelegy is not intended for relief of acute symptoms - this is where albuterol plays its role 2

• Single inhaler advantage: Using Trelegy as a single inhaler for triple therapy may improve adherence compared to multiple inhalers 4, 6

Clinical Algorithm for Use

1. For maintenance: Use Trelegy once daily as prescribed 5

2. For breakthrough symptoms: Use albuterol as needed for immediate relief 3

3. Monitor for:

   • Frequency of albuterol use (increasing use may indicate worsening disease control) 3
   • Signs of pneumonia (increased risk with ICS-containing regimens) 3
   • Adequate symptom control and exacerbation prevention 3

4. Do not: Use ICS monotherapy for COPD as this is not recommended 3

Conclusion

The combination of Trelegy for maintenance therapy and albuterol for rescue therapy represents an evidence-based approach for COPD management, particularly for patients with moderate to severe disease and high exacerbation risk 3, 2.