Some people with asthma need to use multiple inhaled medicines each day to keep their symptoms under control. The approval of long-acting, combination inhalers that contain more than one medicine is changing the way that asthma is treated. Instead of using multiple inhalers multiple times per day, many people are now able to use only one inhaler each day to keep their symptoms under control.
One of these new inhalers that contains a combination of long-acting medicines is called Trelegy Ellipta. It is the first inhaler that contains three medicines to treat asthma. You may hear this called “triple therapy.”
How Does Trelegy Work for Asthma?
Asthma is a long-term (chronic) condition of the lungs that can make it hard to breathe. The airways can get narrowed from swelling (inflammation) and because the muscles in the airways tighten up. This swelling and tightness can make the airways very irritated and sensitive. The airways can also become clogged with mucus.
People with asthma can have asthma attacks, which can include coughing, wheezing, a hard time breathing, and tightness or pain in the chest. A lot of “triggers” can cause an asthma attack. Some examples of common triggers are listed below.
- Infection
- Pollen
- Pet dander
- Dust mites
- Strong smells
- Smoke
- Cold air
The key to treating asthma is to reduce the amount of swelling and tightness in the lungs. This helps make it easier to breathe. It also makes the lungs less sensitive to triggers, which can reduce the number of asthma attacks.
Trelegy Ellipta contains three medicines that work to reduce swelling and relax the muscles in the airways.
- Fluticasone furoate is a medicine that reduces swelling. It is an inhaled corticosteroid (ICS).
- Umeclidinium is a medicine that helps the muscles in the airways relax. It is an anticholinergic medicine. You may also hear it called a long-acting muscarinic antagonist (LAMA).
- Vilanterol is another medicine that helps the muscles in the airways relax. It is a long-acting beta-2 agonist (LABA) medicine.
Umeclidinium and vilanterol are both “bronchodilators.” These two medicines work in different ways to relax the muscles in the airways.
Will I Still Need to Use Any Other Inhalers?
For some people with asthma, this will be the only inhaler that needs to be used every day to prevent and control asthma symptoms. Do not use other long-acting, daily inhalers unless your health care provider says that you should.
You should always have access to a “rescue inhaler.” An example is albuterol. These inhalers give quick relief of symptoms and should be used when you are having sudden trouble breathing or are having an asthma attack. Trelegy is a “maintenance” inhaler that should only be used to prevent asthma symptoms. It should not be used to manage sudden breathing issues.
How Do I Use the Inhaler?
Inhale one puff once daily, at the same time each day. After inhaling, rinse your mouth out with water and spit the water out into the sink. This is important to help lower your chance of getting a yeast infection in the mouth or throat, called oral thrush.
It is important for you to use the inhaler properly so that you get the right dose. Your prescription should come with “Instructions for Use,” which explains how to prepare your dose, inhale the medicine, and when to refill your inhaler. For example, you should not open the cover of the inhaler until you are ready to use it, or you may lose the dose. Ask your pharmacist or other health care provider if you are unsure how to use your inhaler.
The CAPTAIN Study
The CAPTAIN study looked at the safety and efficacy of Trelegy for treating asthma. Everyone in the study was already using two inhaled long-acting medicines each day but still had asthma symptoms. A little more than half of people in this study were female and most were White (80%). The average age was 53 years old. This study compared Trelegy to another inhaler (Breo Ellipta) that contained two long-acting medicines, fluticasone furoate and vilanterol. Trelegy contains these same two medicines, plus another medicine called umeclidinium.
People were told to use their inhaler once each day for at least 6 months. If they had sudden trouble breathing, they were told to use their rescue inhalers. People in the study did not know whether their inhaler had two medicines or three medicines.
Efficacy was measured by asking people to take a deep breath and then force as much air out of their lungs as possible. The amount of air that a person could force out of their lungs in 1 second was recorded. This measure helps to understand how well the lungs are working.
What Were the Benefits?
Breathing function. After 6 months of using the inhaler each day, the people who used Trelegy were able to force more air out of their lungs than the people who used the other inhaler. This means that people who used Trelegy Ellipta were able to move air through their lungs more easily.
The study also looked at asthma symptoms. People in the study completed surveys to help see how their asthma symptoms were affected. When a person has fewer asthma symptoms, this means their asthma is under better control. One of the surveys asked about the following items.
- Waking up at night because of asthma
- Symptoms of asthma in the morning
- Problems doing normal activities because of asthma
- How often wheezing happens
- Trouble breathing because of asthma
- How often a rescue inhaler is used
More than half of people (58% with a lower dose and 63% with a higher dose) had noticeable improvement in symptoms while using Trelegy. More than half of people (55%) using the inhaler with two medicines also had a noticeable improvement in symptoms.
This study only looked at people who were already using two long-acting medicines each day but still had symptoms. If you are already using two long-acting medicines each day and do not have symptoms, you may not need triple therapy.
How Long Does Trelegy Take to Work?
You should have less trouble breathing after using it for a few weeks or months. For some people, this might mean there will be fewer sudden breathing issues. Do not stop using it without talking to your health care provider first, even if your breathing has gotten better. Your breathing may get worse again once you stop it.
How to Prevent and Manage Side Effects
The most common side effects are infections of the airways. These include infection in the nose or throat, a sore throat, or common cold symptoms. This can also include lung infections, such as bronchitis or pneumonia. The best way to prevent infection is to reduce your exposure to germs by washing your hands and avoiding people who are sick. You should also stay current on vaccinations, such as getting an annual flu vaccine.
A yeast infection in the mouth or throat, called oral thrush, may also happen. The best way to prevent this infection is to rinse your mouth with water after each dose and then spit the water out into the sink.
These are not all of the possible side effects. Talk with your health care provider if you are having symptoms that bother you. In the U.S., you can report side effects to the FDA at www.fda.gov/medwatch or by calling 800-FDA-1088 (800-332-1088). In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.
Are There Any Drug Interactions?
Several medicines can affect the blood levels of the ingredients in Trelegy and increase the risk of side effects. Tell your doctor if you are taking the antibiotic clarithromycin, any medicines for HIV or AIDS, or any medicines for a fungal infection. Also tell your doctor if you are using any medicines for heart problems or blood pressure.
Many other inhalers for asthma contain medicines that are the same as or similar to those in Trelegy. If you switch to Trelegy Ellipta, you may need to stop using an inhaler you were using before. Talk with your health care provider if you are unsure which inhalers to use daily or as needed.
This is not a complete list of interactions. Tell your pharmacist or other health care provider about all the prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, or other supplements you take or have recently taken.
Is There a Cost Savings Program?
A savings coupon may allow you to pay $0 for your prescription. Whether you are eligible depends on whether you have prescription insurance and what type of insurance you have. You can find out more at https://www.trelegy.com/savings-and-coupons/.
