The combination treatment of fluticasone and vilanterol  (brand name, Breo ellipta) is a once-daily medicine used as a maintenance therapy for airway obstruction and to reduce sudden flares caused by COPD. It is a combination of an inhaled corticosteroid (fluticasone) and a long-acting bronchodilator (vilanterol).
How does fluticasone-vilanterol for COPD work?
Fluticasone is a synthetic trifluorinated corticosteroid with anti-inflammatory activity that works to reduce airway swelling. Vilanterol is a long-acting selective beta2-agonist (LABA) bronchodilator with a rapid onset of action that works by relaxing and opening the airways to the lungs, making breathing easier.
The anti-inflammatory activity of fluticasone aims to alter the pathogenesis, or biological mechanisms, of COPD, although the precise mechanism by which it does so is not fully understand. In this disease, the major inflammatory agents include multiple cell types (mast cells, eosinophils, neutrophils, macrophages and lymphocytes) and mediators (histamine, eicosanoids, leukotrienes and cytokines). Corticosteroids have been shown to have a wide range of actions on these cell types and mediators involved in inflammation.
As a selective LABA, vilanterol’s effects are due to the stimulation of an enzyme, called adenyl cyclase, inside lung muscle cells. This enzyme helps convert adenosine triphosphate (ATP) to cyclic adenosine monophosphate (cAMP). When the levels of cAMP increase, the muscle cells relax, and the increase blocks the release of mediators of immediate hypersensitivity from mast and other cells.
Beta2-receptors (LABA) are predominant in the muscle cells of the lungs, but they are also present in the heart, which means vilanterol may have cardiac effects, such as irregular heartbeats.
Studies of fluticasone-vilanterol
The safety and efficacy of a fluticasone-vilanterol combination were evaluated in studies involving almost 8,000 people with COPD. Fluticasone-vilanterol at 100/25 mcg (Breo ellipta) demonstrated a greater improvement in mean FEV1 (a measure of lung health) relative to placebo and fluticasone alone.
A recent systematic review of all randomized and placebo-controlled studies longer than eight weeks assessed the efficacy and safety of  fluticasone-vilanterol, versus either of these drugs alone, in treating people with severe to very severe stable COPD. The combination was associated with a decrease in the rate of COPD exacerbations, without adverse cardiovascular affects.
Indications and side effects
The combination fluticasone-vilanterol comes as a powder that is inhaled (using a supplied device) in a deep, steady breath, a brief pause and then by a slow and easy exhalation. and is usually used once a day. It is not intended to relieve sudden breathing problems and does not replace a short-acting bronchodilator.
The most common side effects of fluticasone-vilanterol  may include headache, nervousness, uncontrollable shake of part of the body, joint pain and runny nose and sore throat.
There is no generic available at this time.
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