Breo Vs. Trelegy: What Is The Difference?

jmbowen70 asked

I have been taken Breo and now my new doctor has changed me to Trelegy. What I want to know is if the side effects are the same for both inhalers?

Answer

There are several FDA-approved inhalers for the maintenance and treatment of COPD (chronic obstructive pulmonary disease). Two of the most commonly prescribed are:

• Breo Ellipta
• Trelegy Ellipta

Below, I detail the differences between them (including the side effects which you are concerned about).

Breo Vs. Trelegy: Active Ingredients

The main difference between Breo and Trelegy are the active ingredients in both.

Breo contains:

• Vilanterol
• Fluticasone furoate

Trelegy contains:

• Vilanterol
• Fluticasone furoate
• Umeclidinium

As you can see, Breo and Trelegy share two of the same active ingredients (vilanterol and fluticasone furoate) but Trelegy contains one additional, umeclidinium. All of these active ingredients are discussed below.

Vilanterol

Vilanterol is classified as a long-acting beta-2 adrenergic agonist, or LABA, for short.

It acts on 'beta-2 receptors' in the lungs, which causes the relaxation of smooth muscle in the airways. This relaxation results in increased airflow. Vilanterol acts on the same receptors as albuterol, but is much longer lasting, which is why it is classified as a 'LABA'. Albuterol is known as a SABA (short-acting beta-agonist).

Vilanterol is in both Breo and Trelegy.

Fluticasone Furoate

Fluticasone furoate is a corticosteroid, which acts on many different cells involved in inflammatory pathways. Cells it acts on include:

• Mast cells
• Eosinophils
• Neutrophils
• Macrophages
• Lymphocytes

Corticosteroids also act on inflammatory mediators, such as histamine and leukotrienes.

Fluticasone furoate is similar to fluticasone propionate (the active ingredient in Flovent), but binds more strongly to corticosteroid receptors.

Vilanterol is in both Breo and Trelegy.

Umeclidinium

Umeclidinium is an anticholinergic. It not only causes dilation of the muscles of the airways (i.e. bronchodilation) but also helps to dry mucous and saliva secretions. The overall result is increased airflow.

Anticholinergics are often used for the treatment of COPD. Aside from umeclidinium, Spiriva (tiotropium) is another commonly used anticholinergic.

Breo Vs. Trelegy: Use

Breo is FDA-approved for the treatment of asthma and is a first-line recommended treatment for COPD.

Trelegy, on the other hand, is only FDA approved for the treatment of COPD, but only as a second-line option according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines.

The GOLD guidelines recommend that 'triple combination products', like Trelegy should be reserved for those who have already tried a two-ingredient product, like Breo. Studies referenced in the GOLD guidelines state that, in these particular individuals, triple combination therapy improves lung function and associated symptoms.