Are Breo and Trelegy the Same Class of Medication for COPD?
No, Breo (fluticasone/vilanterol) and Trelegy (fluticasone/umeclidinium/vilanterol) are not the same class—Breo is a dual therapy combining an inhaled corticosteroid (ICS) with a long-acting beta-agonist (LABA), while Trelegy is a triple therapy that adds a long-acting muscarinic antagonist (LAMA) to the ICS/LABA combination. 1, 2
Medication Composition and Classification
Breo Ellipta (Fluticasone Furoate/Vilanterol)
- Contains two drug classes: 3
- Fluticasone furoate (ICS)
- Vilanterol (LABA)
- Classification: ICS/LABA dual combination therapy 4
Trelegy Ellipta (Fluticasone Furoate/Umeclidinium/Vilanterol)
- Contains three drug classes: 1, 2
- Fluticasone furoate (ICS)
- Umeclidinium (LAMA)
- Vilanterol (LABA)
- Classification: ICS/LAMA/LABA triple combination therapy 4
Clinical Positioning in COPD Treatment
When to Use Breo (ICS/LABA Dual Therapy)
Breo is appropriate for patients with moderate to high symptom burden (CAT ≥10, mMRC ≥2) and impaired lung function (FEV₁ <80% predicted) who have concomitant asthma features. 4 However, LAMA/LABA dual therapy is generally preferred over ICS/LABA in COPD patients without asthma due to superior lung function improvements and lower pneumonia risk. 4
When to Use Trelegy (Triple Therapy)
Trelegy is indicated for patients at high risk of exacerbations (≥2 moderate exacerbations or ≥1 severe exacerbation requiring hospitalization in the past year) with moderate to high symptom burden and impaired lung function (FEV₁ <80% predicted). 4
- Triple therapy demonstrates greater reduction in exacerbation rates compared to dual therapies 2, 5
- Single-inhaler triple therapy (like Trelegy) is preferred over multiple-inhaler combinations 4
Comparative Efficacy Evidence
Lung Function
Triple therapy with fluticasone furoate/umeclidinium/vilanterol produces significantly greater improvements in FEV₁ compared to ICS/LABA dual therapy. 5, 6 The addition of umeclidinium (LAMA) to fluticasone/vilanterol provides sustained bronchodilation beyond what ICS/LABA alone achieves. 2
Exacerbation Prevention
Triple therapy is more effective than ICS/LABA combinations at reducing moderate-to-severe exacerbation rates. 2, 5 The IMPACT study demonstrated that umeclidinium/fluticasone furoate/vilanterol had greater effects on reducing exacerbations compared to fluticasone furoate/vilanterol dual therapy. 2
Important Clinical Caveats
Pneumonia Risk
ICS-containing regimens (both Breo and Trelegy) carry an increased risk of pneumonia compared to bronchodilator-only therapy. 4 This risk must be weighed against exacerbation reduction benefits, particularly in patients with frequent exacerbations. 4
Stepwise Approach
Current guidelines recommend starting with LAMA/LABA dual therapy (not ICS/LABA) for most symptomatic COPD patients, reserving triple therapy for those with persistent exacerbations despite dual bronchodilator therapy. 4 The exception is patients with COPD and concomitant asthma, where ICS/LABA (Breo) may be the initial dual therapy choice. 4
Avoiding ICS Monotherapy
Neither medication should be used as ICS monotherapy—inhaled corticosteroids in COPD must always be combined with long-acting bronchodilators. 4 ICS monotherapy is specifically recommended against in all patients with stable COPD at low risk of exacerbations due to lack of benefit and increased adverse event risk. 4