What is the recommended use of Trelegy Ellipta (fluticasone furoate, umeclidinium, vilanterol) for patients with chronic obstructive pulmonary disease (COPD) or asthma?

Trelegy Ellipta (Fluticasone Furoate, Umeclidinium, Vilanterol) for COPD and Asthma

Trelegy Ellipta is indicated for maintenance treatment of moderate to severe COPD in patients who are not adequately controlled on dual therapy, and for maintenance treatment of asthma in patients aged 5 years and older. 1

Indications and Dosing

For COPD:

• Recommended for patients with moderate to severe COPD who have persistent symptoms and high exacerbation risk, particularly those with FEV₁ <60% predicted who are not adequately controlled on dual therapy 2
• Dosage: 1 actuation of Fluticasone Furoate/Vilanterol ELLIPTA 100/25 mcg once daily administered by oral inhalation 1

For Asthma:

• Indicated for maintenance treatment of asthma in patients aged 5 years and older 1
• Adult dosing (18+ years): 1 actuation of Fluticasone Furoate/Vilanterol ELLIPTA 100/25 mcg or 200/25 mcg once daily 1
• Adolescent dosing (12-17 years): 1 actuation of Fluticasone Furoate/Vilanterol ELLIPTA 100/25 mcg once daily 1
• Pediatric dosing (5-11 years): 1 actuation of Fluticasone Furoate/Vilanterol ELLIPTA 50/25 mcg once daily 1

Treatment Algorithm for COPD

1. Initial Assessment:

   • For patients with FEV₁ <60% predicted and respiratory symptoms, inhaled bronchodilators are strongly recommended 3
   • For patients with moderate symptoms (CAT ≥10, mMRC ≥2) and FEV₁ <80% predicted, LAMA/LABA dual therapy is recommended as initial maintenance therapy 2

2. Progression to Triple Therapy:

   • Consider Trelegy Ellipta (triple therapy) when patients are not adequately controlled on dual therapy 2, 4
   • Particularly beneficial for GOLD Group D patients with high exacerbation risk 5
   • Blood eosinophil counts ≥150 cells/mm³ may predict better response to ICS-containing regimens like Trelegy 2

3. Clinical Benefits:

   • Triple therapy has demonstrated improvements in lung function, symptoms, quality of life, and reduction in moderate-severe exacerbations compared to dual therapies 6, 7
   • Real-world studies show significant improvements in dyspnea, health status, exacerbation rates, and lung function parameters after 24 weeks of treatment 7

Special Considerations

• Asthma-COPD Overlap: ICS-containing regimens like Trelegy are particularly important for patients with features of asthma-COPD overlap 2
• Cardiovascular Comorbidities: Consider cardiovascular status when using LABA-containing medications like Trelegy 2
• Not for Acute Symptoms: Trelegy is NOT indicated for the relief of acute bronchospasm 1
• Infection Risk: Monitor for Candida albicans infection of the mouth and pharynx; advise patients to rinse mouth with water without swallowing after inhalation 1
• Pneumonia Risk: Increased risk of pneumonia in COPD patients using ICS-containing regimens; monitor for signs and symptoms 1

Common Pitfalls to Avoid

• Failing to reassess therapy effectiveness after initiating or switching medications 2
• Not considering comorbidities when selecting therapy 2
• Using triple therapy in patients who may be adequately controlled on monotherapy or dual therapy 2
• Not providing proper inhaler technique education, which is crucial for effective medication delivery 2
• Abrupt discontinuation in patients with asthma-COPD overlap can lead to deterioration 5

Advantages of Trelegy Ellipta

• Once-daily administration improves convenience and may enhance adherence 8, 9
• Single inhaler delivery system simplifies the treatment regimen 8
• The dry powder inhaler device has shown good patient acceptance and preference 8

I'm human: I noticed the response doesn't include information about the specific components of Trelegy Ellipta. Could you please explain what fluticasone furoate, umeclidinium, and vilanterol are and how they work together in COPD and asthma management?