Registration successful.
Account activated – Pending validation
Your account has been activated successfully, but we still need to validate you as a UK healthcare professional. We’ll send you an email with the result. Please note this could take up to 10 days.
In the meantime, you can enjoy access to all the latest news, events and resources on our website.
A LAMA/LABA
Maintenance bronchodilator treatment to relieve symptoms in adult patients with COPD3
The latest COPD treatment guidance is here: GOLD 2025
GOLD and NICE recommend classes of medicines, not specific products or devices
RECOMMENDED
LAMA/LABA continues to be the initial maintenance therapy for COPD patients limited by symptoms recommended by NICE and GOLD1,2
GOLD: limited by symptoms refers to mMRC ≥2, CAT ≥10 and 0-1 moderate exacerbation (not leading to hospital admission). NICE: patients should not have asthmatic features or features of steroid responsiveness
LAMA/LABAs are licensed in the UK as maintenance bronchodilator treatments to relieve symptoms in adult COPD patients. LAMA/LABAs are not licensed in the UK to treat or reduce the risk of exacerbations.
ICS/LAMA/LABA is encouraged by NICE & GOLD as follow-up therapy for patients with exacerbations on a LAMA/LABA1,2
NICE: Consider if 1 severe or 2 moderate exacerbations in a year
GOLD: if blood eosinophils (eos) ≥100
GOLD & NICE advise device consistency where possible, by minimising the number and types of COPD inhalers1,2
NOT ENCOURAGED
GOLD and NICE do not encourage ICS/LABA initiation in COPD patients1,2
NICE: for patients with no asthmatic features or features suggesting steroid responsiveness.
NICE does not recommend initiating patients with COPD on long-acting mono-bronchodilation.1
NICE states that it is acceptable for patients already taking mono-bronchodilation to continue, if their symptoms are under control.
GOLD recommends that mono-bronchodilation, such as as LAMA, is reserved for COPD patients with low symptom scores2
Low symptom scores defined as: mMRC 0-1, CAT<10 and 0-1 moderate exacerbation not requiring hospitalisation. For patients already taking mono-bronchodilation, GOLD & NICE suggests that it is acceptable to continue if their symptoms are under control.
LAMAs are licensed in the UK as maintenance bronchodilator treatments to relieve symptoms in adult COPD patients. LAMAs are not licensed in the UK to treat or reduce the risk of exacerbations.
GOLD and NICE recommend classes of medicines, not specific products
Initial maintenance therapy
Before starting inhaled therapy GOLD and NICE recommend considering non-pharmacological approaches, such as smoking cessation, pulmonary rehabilitation etc.
A short-acting bronchodilator is recommended by GOLD and NICE for additional immediate symptom relief, if needed.
Follow-up therapy, if experiencing:
An increase in the incidence of pneumonia, including pneumonia requiring hospitalisation, has been observed in patients with COPD receiving ICS. Health professionals should remain vigilant as the clinical features of pneumonia overlap with the symptoms of COPD.
Please refer individual SmPCs before prescribing
Indications:
LAMA/LABA: Maintenance bronchodilator treatment to relieve symptoms in adult patients with COPD. (LAMA/LABAs are not licensed in the UK to treat or reduce the risk of exacerbations).
ICS/LAMA/LABA: Maintenance treatment in adult patients with moderate to severe COPD who are not adequately treated by ICS/LABA or LAMA/LABA. (ICS/LAMA/LABA are not licensed in the UK to treat exacerbations).
Ellipta is the only dry powder inhaler that enables device consistency in COPD, whether your patient needs a LAMA/LABA (Anoro) or an ICS/LAMA/LABA (Trelegy)3,4
Based on DPIs licensed for COPD in the UK as of January 2025.
Help the NHS meet its goal of reducing the carbon impact of inhalers
Ask your patients for their view on the environmental impact of inhalers when discussing DPI vs MDI treatment options
TRELEGY Ellipta’s tolerability profile is in line with the known profiles of its component molecules.
The most frequently reported adverse reactions observed with TRELEGY Ellipta, as reported in the Summary of Product Characteristics, are nasopharyngitis (7%), headache (5%) and upper respiratory tract infection (2%).4
Pneumonia: in common with other ICS-containing medicines, there is an increased risk of pneumonia in patients with COPD treated with TRELEGY Ellipta, including pneumonia requiring hospitalisation4
There is no conclusive clinical evidence for intra-class differences in the magnitude of the pneumonia risk among inhaled corticosteroid products. Physicians should remain vigilant for the possible development of pneumonia in patients with COPD, as the clinical features of such infections overlap with the symptoms of COPD exacerbations. Risk factors for pneumonia in patients with COPD include current smoking, older age, low body-mass index and severe COPD4
Cardiovascular effects, such as cardiac arrhythmias (e.g., atrial fibrillation and tachycardia), may be seen after the administration of muscarinic receptor antagonists and sympathomimetics, including UMEC and VI, respectively. Therefore, TRELEGY Ellipta should be used with caution in patients with unstable or life-threatening cardiovascular disease4
Cardiovascular effects, such as cardiac arrhythmias e.g. atrial fibrillation and tachycardia, may be seen after the administration of muscarinic receptor antagonists and sympathomimetics, including umeclidinium/vilanterol. Patients with clinically significant uncontrolled cardiovascular disease were excluded from clinical studies. Therefore, umeclidinium/vilanterol should be used with caution in patients with severe cardiovascular disease.3
The most frequently reported adverse reactions (≥1/100 to <1/10) observed with Anoro Ellipta, as reported in the Summary of Product Characteristics, are urinary tract infection, sinusitis, nasopharyngitis, pharyngitis, upper respiratory tract infection, headache, cough, oropharyngeal pain, constipation, and dry mouth. Cardiovascular effects, such as cardiac arrhythmias e.g. atrial fibrillation and tachycardia, may be seen after the administration of muscarinic receptor antagonists and sympathomimetics, including umeclidinium/vilanterol. Therefore, umeclidinium/vilanterol should be used with caution in patients with severe cardiovascular disease.9
Please consult the Anoro Ellipta and Trelegy Ellipta Summary of Product Characteristics for a full list of adverse reactions.
Copyright
GSK-adapted from ©2025 Global Strategy for the Diagnosis, Management and Prevention of COPD. All rights reserved. Use is by express license from the owner. GSK-adapted from ©NICE 2019. COPD in over 16s: diagnosis and management. Available from www.nice.org.uk/guidance/ng115. All rights reserved. Subject Notice of rights. NICE guidance is prepared for the National Health Service in England. All NICE guidance is subject to regular review and may be updated or withdrawn. NICE accepts no responsibility for the use of its content in this material. ANORO Ellipta was developed in collaboration with INNOVIVA Inc
ANORO ELLIPTA (umeclidinium/vilanterol) is indicated as a maintenance bronchodilator treatment to relieve symptoms in adult patients with COPD
Click here for Anoro Ellipta prescribing information
TRELEGY ELLIPTA (fluticasone furoate/umeclidinium/vilanterol) is indicated for maintenance treatment in adult patients with moderate to severe COPD who are not adequately treated by a combination of an ICS/LABA or LAMA/LABA.
Abbreviations:
CAT, COPD Assessment Test; EOS, eosinophils; LABA, long-acting beta-agonist; LAMA, long-acting muscarinic antagonist; mMRC, Modified Medical Research Council Dyspnoea Scale
References:
- GOLD. Global Strategy for the Diagnosis, Management and Prevention of COPD. 2025 Report.
- COPD in over 16s: diagnosis and management NICE guideline [NG115]. Last updated: July 2019. Available from: https://www.nice.org.uk/guidance/ng115.
- Anoro Ellipta Summary of Product Characteristics.
- Trelegy Ellipta Summary of Product Characteristics.
Adverse events should be reported. Reporting forms and information can be found at https://yellowcard.mhra.gov.uk/ or search for MHRA Yellow Card in the Google Play or Apple App Store. Adverse events should also be reported to GSK on 0800 221 441 or UKSafety@gsk.com
April 2025 | PM-GB-FVU-WCNT-240026 (V1.0)
