Trelegy Ellipta is the most advanced form of treatment currently prescribed for people suffering from Chronic Obstructive Pulmonary Disease (COPD). It is usually recommended once the condition has progressed from the earlier stage of mild symptoms into the more severe stages, all the way through to stage four when airflow becomes highly limited, and quality of life becomes poor due to extreme breathlessness.
About Trelegy Ellipta
Trelegy Ellipta is a once-daily, three-in-one treatment for COPD, delivering three essential medications in a single dose through the inhaler. Trelegy Ellipta helps patients in all more advanced stages of COPD breathe more easily through improved lung function. It also acts to prevent flare-ups which become more prevalent as the condition progresses.
A Trelegy Ellipta inhaler supplies three different long-acting medicines into a single-dose inhaler that provides a full 24 hours of improved breathing. With the unique combination of these three substances working in step, Trelegy Ellipta can help people with COPD breathe more easily, improve lung function and help to prevent future flare-ups.
The three components combined in the Trelegy Ellipta inhaler are:
- LABA (long-acting beta2-adrenergic agonist), which acts as a bronchodilator by relaxing the muscles around the airways into the lungs
- LAMA (long-acting muscarinic antagonist), which is also a bronchodilator that acts to keep the airways open by blocking tightening of the smooth muscles surrounding them
- ICS (inhaled corticosteroid), which is an anti-inflammatory drug that reduces inflammation and swelling inside the lungs.
It’s important to note, though, that Trelegy Ellipta does not replace a rescue inhaler that may be prescribed in cases where sudden flare-ups do occur.
About Chronic Obstructive Pulmonary Disease
The Global Allergy and Airways Patient Platform provides a good explanation of COPD’s prevalence, diagnosis, and treatment, which we will summarize here.
As indicated by the generic name given to the condition, it is chronic, given that it is a long-term and persistent condition for which there is currently no cure. The effects of the condition are obstructive because it causes airways in the lungs to become narrowed, and pulmonary refers to all conditions affecting the lungs.
Doctors use the Global Initiative on Obstructive Lung Disease (GOLD) system to classify the degree of severity. They use a forced expiratory volume (FEV1) test that measures how much air a patient can forcefully breathe out in one second when blowing into a specially designed device called the spirometer.
According to the GOLD system, there are four stages of COPD, which rate the degree of lost aspiration. These range from GOLD 1, equating to mild COPD, measuring 80% FEV1 or higher, through moderate (GOLD 2 measuring less than 80% FEV1 but more than 50%), then severe (GOLD 3 measuring less than 50% FEV1 but more than 30%) and finally very severe (GOLD 4 measuring less than 30% FEV1).
What are the leading causes of COPD?
The condition develops mainly because of long-term damage to the lungs that result in them becoming narrowed, inflamed and then obstructed. Among the main causes of COPD are:
- a history of prolonged smoking
- exposure to air pollution and secondhand smoke or dust
- exposure to toxic fumes or chemicals at work.
COPD also shows some age-related patterns since it tends to develop after the age of 35. However, people are often unaware that the warning signs should not simply be attributed to getting older, often resulting in cases not being diagnosed until people are already in their 50s. This is because people are often unaware of the warning signs, and the condition may already have become advanced.
It also has some element of inheritability in cases where there has been a history of chronic lung disease in the family that did not arise from the above causes. Research currently points out that having smaller airways relative to the size of the lungs could predispose people to an increased risk of COPD.
In cases where it begins to affect people at a younger age, it may be due to the genetic condition known as alpha-1-antitrypsin deficiency (which is rare) or to a chest infection in childhood that may have scared the lungs.
The widely-held assumption that COPD is due primarily to smoking has been disproven. Even heavy smokers do not all develop COPD, and in fact, for almost one-third of cases, the people have never smoked.
There are about 17 million cases of COPD in the US, and some projections indicate that by the end of this decade, it may have become the third leading cause of death in the world.
Other lung diseases can end up as causes of COPD. Chronic bronchitis causes irritation and inflammation to the bronchial tubes. It results in a build-up of mucus or phlegm along the linings that causes damage to the air sacs, resulting in narrowing of the openings, making it harder to move air into and out of the lungs.
Emphysema causes the alveoli (the walls of the air sacs located in the lower end of the bronchial tubes) to collapse. The air sacs play a vital role in transferring oxygen into blood cells and filtering carbon dioxide out.
In cases of chronic bronchitis or emphysema, or a combination of both conditions, the lung damage may lead to a diagnosis of COPD.
What are the longer-term outcomes for people with COPD?
There is currently no cure for the condition because the damage to the lungs cannot be reversed. If left untreated, it probably will worsen over time, leading to an increased risk of hospitalizations and may even become life-threatening.
However, proper treatment with the right medication like Trelegy Ellipta and good supervision by medical carers and lifestyle adjustments can manage it toward better outcomes.
What are the current treatments for COPD?
Since there is no complete cure for COPD, it needs to be managed and treated to slow down damage to the lungs and relieve the symptoms. The most widely recommended medications that doctors may prescribe include:
- Inhaled bronchodilators to open up the airways
- Steroids delivered via an inhaler to reduce swelling in the airways
This is where Trelegy Ellipta has made its most significant contribution in the treatment of COPD, because it combines both bronchodilators and steroids in a single-dose delivery through a simple inhaler.
In some cases, doctors will prescribe an exercise programme under the supervision of a physiotherapist, helping the patient learn to breathe more easily.
In the more severe cases where there are low blood oxygen levels, it may be necessary to implement oxygen therapy using an oxygen tank at home or portable. In the end, if these treatments are not providing sufficient relief when COPD is very severe, surgery to remove damaged sections of the lungs can be undertaken to improve airflow.
What are the signs and treatments for COPD flare-ups?
Occasionally, the symptoms of COPD can flare up without warning. In some cases, it may be triggered by exposure to higher levels of pollution, secondhand smoke or after suffering some form of infection. In such an instance of a flare-up, it needs to be treated with a plan drawn up by a doctor familiar with the patient’s symptoms and treatment needs.
In most cases of flare-ups, a fast-acting bronchodilator, such as fast-acting “rescue” bronchodilators containing albuterol (Ventolin and DuoNeb), should have been prescribed and kept on hand.
Such a flare-up plan could comprise antibiotics or additional steroids to reduce the symptoms or lead to hospitalization in severe cases.
As we pointed out in the introduction, Trelegy Ellipta does not replace a rescue inhaler that may be prescribed in cases where sudden flare-ups do occur.
There is no complete cure for COPD, and the lung damage caused as it progresses cannot be reversed. However, improvement in the symptoms and frequency of flare-ups are possible, especially if it has been diagnosed early and appropriate treatment such as Trelegy Ellipta has begun. It also means that further lung damage can be prevented.
Sources for further reading
American Lung Association – Learn About COPD.
BMJ Best Practice – Chronic Obstructive Pulmonary Disease