Breo Ellipta

The typical dosages of Breo Ellipta depend on the condition being treated:

• For Asthma: The usual dose is one inhalation of Breo Ellipta 100/25 mcg or 200/25 mcg once daily, depending on the severity of the asthma and the patient’s response.
• For COPD: The typical dose is one inhalation of Breo Ellipta 100/25 mcg once daily.

Breo Ellipta is contraindicated in patients with:

• Severe hypersensitivity to Fluticasone, Vilanterol, or any component of the formulation.
• Primary treatment of status asthmaticus or other acute episodes of asthma or COPD where intensive measures are required.

Patients using Breo Ellipta should be advised to:

• Use the inhaler exactly as prescribed and not to use it to treat sudden breathing problems (an inhaled short-acting bronchodilator like albuterol should be used for that purpose).
• Rinse their mouth after each use to prevent oral thrush, a common side effect of inhaled corticosteroids.
• Store the inhaler in a dry place, away from moisture and heat.
• Monitor for and report any side effects, such as increased difficulty breathing, heart palpitations, or signs of infection.
• Continue regular follow-up with their healthcare provider to ensure the medication is working effectively and to adjust the dose if necessary.

• Headache
• Throat irritation
• Hoarseness or voice changes
• Cough
• Oral thrush (fungal infection in the mouth)
• Respiratory tract infections, such as pneumonia

• Worsening of Asthma or COPD Symptoms: Especially if the medication is stopped abruptly.
• Paradoxical Bronchospasm: A condition where breathing or wheezing worsens immediately after using the inhaler. This is rare but serious and requires immediate medical attention.
• Increased Risk of Pneumonia: Especially in patients with COPD.
• Effects on the Heart: Such as increased heart rate, palpitations, or high blood pressure.
• Decreased Bone Mineral Density: With long-term use of inhaled corticosteroids.
• Immunosuppression: Long-term use may weaken the immune system, increasing the risk of infections.

Asthma-Related Death: Long-acting beta-2 agonists like Vilanterol, one of the components of Breo Ellipta, have been associated with an increased risk of asthma-related death. This risk is higher when LABAs are used as monotherapy without an inhaled corticosteroid. Breo Ellipta, however, includes both a LABA and an ICS, which reduces this risk.

Pneumonia in COPD Patients: Breo Ellipta may increase the risk of pneumonia in patients with COPD. Patients should be monitored for signs of pneumonia, such as increased sputum production, change in sputum color, fever, or worsening cough.

Growth Suppression in Children: Although Breo Ellipta is not approved for use in children under 18 for asthma or COPD, the long-term use of corticosteroids in general can affect growth in children and adolescents.

Breo Ellipta may interact with other medications, including:

• Beta-blockers: Which may reduce the effectiveness of Vilanterol or cause bronchospasm.
• Strong CYP3A4 inhibitors: Such as ketoconazole or ritonavir, which can increase the levels of Fluticasone and Vilanterol in the blood, leading to an increased risk of side effects.
• Diuretics: Which may increase the risk of hypokalemia (low potassium levels) when used with Breo Ellipta.

Patients should inform their healthcare provider of all medications and supplements they are taking to avoid potential interactions.

Alternative treatments for asthma and COPD include:

• Other combination inhalers: Such as Advair (Fluticasone/Salmeterol), Symbicort (Budesonide/Formoterol), or Dulera (Mometasone/Formoterol).
• Inhaled corticosteroids (ICS): As monotherapy, such as Fluticasone or Budesonide, particularly in patients with asthma who may not require a LABA.
• Short-acting beta-2 agonists (SABAs): Such as Albuterol for relief of acute symptoms.
• Long-acting muscarinic antagonists (LAMAs): Such as Tiotropium, for COPD management.

The choice of treatment depends on the specific condition, severity of symptoms, and the patient's response to previous treatments.