Ellipta Dosage for Shortness of Breath
For COPD-related shortness of breath, use fluticasone furoate/vilanterol (Ellipta) 100/25 mcg as one inhalation once daily, and use a short-acting beta2-agonist (such as albuterol) for immediate relief of breakthrough shortness of breath between doses. 1, 2
COPD Maintenance Treatment
The FDA-approved dosage for COPD is fluticasone furoate 100 mcg/vilanterol 25 mcg (Ellipta 100/25) as one inhalation once daily by oral inhalation. 1, 2
- This is the only approved strength for COPD maintenance treatment 1, 2
- The medication should be taken at the same time every day 1, 2
- Do not use more than once every 24 hours 1, 2
- Onset of action occurs approximately 15 minutes after inhalation, though individual response varies 2
Rescue Medication for Acute Shortness of Breath
Ellipta is NOT indicated for relief of acute shortness of breath. 2
- If shortness of breath occurs between doses, use an inhaled short-acting beta2-agonist (e.g., albuterol) for immediate relief 1, 2
- Ellipta is a maintenance medication only, not a rescue inhaler 2
Administration Technique
After each inhalation, rinse the mouth with water without swallowing to reduce the risk of oral thrush (candidiasis). 1, 2
- Use the Ellipta device at the same time daily for optimal adherence 1, 2
- More frequent administration or greater number of inhalations increases risk of adverse effects 1
Clinical Evidence for COPD
In patients with moderate to very severe COPD, fluticasone furoate/vilanterol 100/25 mcg once daily improved pulmonary function more than placebo and fluticasone furoate alone, and improved exacerbation rates more than vilanterol alone 3. The combination was more effective than twice-daily fluticasone propionate/salmeterol 250/50 mcg for pulmonary function 3.
The SUMMIT trial in 16,485 patients with moderate COPD and cardiovascular risk showed that fluticasone furoate/vilanterol reduced the rate of FEV1 decline by 8 mL per year compared to placebo and reduced moderate and severe exacerbations, with no excess risk of pneumonia (6% vs 5% placebo) or cardiac events 4.
Common Pitfalls to Avoid
- Never use Ellipta as a rescue medication for acute shortness of breath—this is a maintenance therapy only 2
- Do not exceed one inhalation per 24 hours—more frequent dosing increases adverse effects without additional benefit 1
- Do not use the 200/25 mcg strength for COPD—this higher dose is only approved for asthma, not COPD 1, 2
- Ensure patients understand the difference between maintenance and rescue therapy—confusion about this distinction is common and can lead to inadequate treatment of acute symptoms 1, 2
Safety Considerations
The combination was generally well tolerated in clinical trials, with fewer than 15% of patients experiencing treatment-related adverse events 5. The most common adverse events were oral/oropharyngeal candidiasis, dysphonia, extrasystoles, and cough 5. Long-term data indicate an increased risk of pneumonia with fluticasone furoate/vilanterol, consistent with the known class effects of inhaled corticosteroids 3, 6.