Beclometasone + formoterol + glycopyrronium: clinical use

Prescribing considerations

• Confirm the exact product indication and licensed asthma criteria.
• Check inhaler technique and adherence; consider AeroChamber Plus where coordination is difficult.
• This is maintenance therapy, not rescue treatment. Deteriorating symptoms or increasing reliever use requires reassessment.
• Use caution with significant cardiovascular disease, QT prolongation, thyrotoxicosis, diabetes, phaeochromocytoma, untreated hypokalaemia, pulmonary tuberculosis or airway infection.
• Assess benefit versus risk in severe renal or hepatic impairment.
• Use cautiously in narrow-angle glaucoma, prostatic hyperplasia or urinary retention.
• Review potential systemic effects of long-term high-dose inhaled corticosteroid exposure.

Contraindications and cautions

• Hypersensitivity to beclometasone dipropionate, formoterol fumarate dihydrate, glycopyrronium bromide or an excipient.

Monitoring

• Asthma symptoms, exacerbations, reliever use and lung function.
• Inhaler technique, adherence, dose counter, oral thrush and dysphonia.
• Serum potassium when hypokalaemia risk is increased.
• Blood glucose in people with diabetes.
• Cardiovascular symptoms or ECG where clinically indicated.
• Visual symptoms, urinary retention and systemic corticosteroid effects.
• Adverse reactions in severe renal or hepatic impairment.

Clinical pharmacology

Beclometasone is converted to an active anti-inflammatory metabolite; formoterol is a selective long-acting beta2 agonist; glycopyrronium is a long-acting muscarinic antagonist with preferential M3 activity. The solution produces an extrafine aerosol.

Formulation and product differences

• The selected product is a high-strength extrafine pressurised inhalation solution licensed for asthma in adults.
• It has a dose counter and is compatible with the AeroChamber Plus spacer.
• Extrafine beclometasone formulations are not directly dose-equivalent to non-extrafine inhalers.
• The formulation contains ethanol and norflurane propellant.
• Storage requirements vary with pack configuration; follow the dispensing label and product information.

Inhaled preparation

Route: Inhaled

Strengths: 87 micrograms + 5 micrograms + 9 micrograms, 88 micrograms + 5 micrograms + 9 micrograms/actuation, 172 micrograms + 5 micrograms + 9 micrograms