From the Guidelines
Using Atrovent alongside Trelegy Ellipta for COPD is not recommended due to therapeutic duplication and potential increased risk of anticholinergic side effects. Trelegy already contains umeclidinium, a long-acting muscarinic antagonist (LAMA), which works similarly to Atrovent, a short-acting muscarinic antagonist (SAMA) 1. According to the Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 report, triple inhaled therapy of ICS/LAMA/LABA improves lung function, symptoms, and health status and reduces exacerbations compared with ICS/LABA or LAMA monotherapy 1.
Key Points to Consider
- Trelegy is a once-daily triple therapy that combines an inhaled corticosteroid (ICS), a LAMA, and a long-acting beta-agonist (LABA), making it a comprehensive treatment for COPD 1.
- The use of Atrovent with Trelegy could lead to increased anticholinergic side effects without providing significant additional benefit 1.
- If COPD symptoms are not adequately controlled with Trelegy alone, discussing alternative treatment options with a healthcare provider is recommended, such as adjusting the current medication regimen or adding a different class of medication 1.
Evidence-Based Recommendation
Based on the evidence from the Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 report 1, the most effective approach for managing COPD is to use a comprehensive treatment regimen like Trelegy, which combines multiple therapeutic classes in a single inhaler. Adding Atrovent to Trelegy would not provide significant additional benefits and could increase the risk of side effects. Therefore, it is recommended to use Trelegy as prescribed and discuss any concerns or inadequate symptom control with a healthcare provider.
From the Research
Atrovent and Trelegy for COPD
- Atrovent is a brand name for the medication ipratropium, which is a long-acting muscarinic receptor antagonist (LAMA) used in the treatment of chronic obstructive pulmonary disease (COPD) 2.
- Trelegy is a brand name for the combination medication fluticasone furoate/umeclidinium/vilanterol, which is a single-inhaler triple therapy used for the maintenance treatment of COPD 3, 4.
- The use of Trelegy as a single-inhaler triple therapy has been shown to be effective in improving lung function, reducing symptoms, and decreasing the rate of exacerbations in patients with COPD 3, 4, 5, 6.
- Studies have compared the efficacy of Trelegy with other treatments, including tiotropium monotherapy, and have found that Trelegy significantly improves lung function and health status in patients with COPD 6.
- The safety profile of Trelegy has been found to be similar to that of other treatments, with no excess cardiovascular effects or pneumonia reported 3, 6.
Combination Therapy
- The combination of a LAMA, such as ipratropium (Atrovent), with a single-inhaler triple therapy, such as Trelegy, is not a standard treatment approach for COPD 2, 3, 4.
- However, the use of a LAMA in combination with other medications, such as inhaled corticosteroids and long-acting β2-adrenoceptor agonists, is a common treatment approach for COPD 2, 3, 4.
- Further studies are needed to determine the efficacy and safety of combining Atrovent with Trelegy for the treatment of COPD 4, 5.