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Fostair and Relvar Ellipta have both been licensed for the symptomatic treatment of severe COPD. Helen Meynell, consultant pharmacist with an interest in respiratory and palliative medicine, Doncaster and Bassetlaw Hospitals NHS Foundation Trust, considers their place in therapy

Fostair (beclometasone 100mcg/formoterol 6mcg) and Relvar Ellipta (fluticasone furoate 92mcg/vilanterol 22mcg) were licensed recently for the symptomatic treatment of patients with severe COPD.

Fostair has been on the market for a number of years for the treatment of asthma at Step 3 and above of the British Thoracic Society/SIGN guidelines. A metered dose inhaler device with an extra-fine particulate formulation, Fostair allows maximal deposition within the airways – 100mcg of beclometasone in the Fostair device is approximately equivalent to 250mcg of standard beclometasone (e.g. in Clenil Modulite).

Relvar Ellipta is a new oncedaily inhaled corticosteroid/long acting beta-agonist (ICS/LABA). It comes in two strengths, but the licensed strength for the management of COPD is the 92/22mcg strength. The approximate equivalence of one puff of Relvar Ellipta 92/22mcg is 500mcg of fluticasone propionate (e.g. in Seretide).

 

Fostair and Relvar Ellipta provide extra choice in COPD

Safety concerns

Concerns have been raised regarding the livery and name of Relvar. The device was originally pale grey with a pale blue sticker – and the name sounds similar to “reliever”. There were concerns that patients may associate the colour and the name of the drug with their usual reliever inhalers (e.g. salbutamol) and take the medicine ‘as required’.

However manufacturer GSK has announced that it is changing the colour of the inhaler mouth-piece cover and associated packaging from blue to yellow to alleviate these concerns. The new packs will begin to be phased in from late January 2015.

The presence of a high potency steroid introduces extra risk potential for patients. Included in the SPC is mention of a 6 per cent increase in pneumonia rates, roughly in keeping with other ICS/LABA combinations.

Extra choice

The licensing of Fostair and Relvar Ellipta in COPD provides extra choice in the management of this condition and reduces the steroid burden. They are also competitively priced compared with, for example, the Seretide 500 accuhaler. Fostair is compatible with the AeroChamber Plus for those patients who are unable to use the device optimally. Fostair is only licensed in patients 18 years and above and requires refrigeration prior to dispensing.

Relvar Ellipta is the first oncedaily ICS/LABA to market.