No dose adjustment is recommended for elderly patients or in patients with mild or moderate renal or hepatic impairment it can be used in patients with severe renal or hepatic impairment if the expected benefits outweigh the risks. The recommended dose is two actuations twice daily (two in the morning and two in the evening). It is licensed as maintenance treatment for adults with moderate to severe COPD who are not adequately treated by a LABA+ICS or a LABA+LAMA. Trixeo Aerosphere is a pressurised metered-dose inhaler delivering 5 micrograms formoterol, 7.2 micrograms glycopyrronium and 160 micrograms budesonide per actuation. Trixeo Aerosphere (formoterol fumarate dihydrate/glycopyrronium bromide/ budesonide) is a triple LABA+LAMA+ICS inhaler launched in the UK in February 2021 for the treatment of moderate to severe COPD. Several dual LABA+LAMA and LABA+ICS inhalers are available for COPD.
ICSVIEWER 2.7 TRIAL
Those previously taking a LABA+LAMA should trial triple therapy for three months and stop if symptoms do not improve.
1 Triple therapy with a long-acting beta 2 agonist (LABA), a long-acting muscarinic antagonist (LAMA) and an ICS is recommended if symptoms impair quality of life despite treatment with dual therapy or the individual has at least one severe exacerbation (requiring hospital admission) or two moderate exacerbations (requiring systemic steroid or antibiotic treatment) within a year. NICE guidance on the management of chronic obstructive pulmonary disease (COPD) recommends maintenance treatment with inhaled bronchodilators using a stepped approach, escalating from a short-acting beta agonist or antimuscarinic agent to combinations of long-acting bronchodilators, with an inhaled corticosteroid (ICS).
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