Trimbow

Trimbow is a triple inhaler that combines three active ingredients in one device: the inhaled corticosteroid beclometasone, the long-acting beta-2 agonist formoterol, and the long-acting anticholinergic glycopyrronium (LAMA).

This triple therapy (ICS/LABA/LAMA) is used in patients who are not adequately controlled with dual therapy (ICS/LABA). Trimbow is approved for the treatment of moderate to severe asthma and COPD.

The extrafine formulation ensures distribution, even in the small airways. Trimbow is available as a metered-dose inhaler and as a Nexthaler (dry powder inhaler).

Trimbow combines three mechanisms of action:

Beclometasone (ICS):

• Anti-inflammatory effect
• Reduces swelling and mucus production
• Lowers bronchial hyperreactivity

Formoterol (LABA):

• Rapid bronchodilation (1-3 minutes)
• Duration of action 12 hours
• Relaxes the bronchial muscles

Glycopyrronium (LAMA):

• Blocks muscarinic receptors
• Additional bronchodilation
• Duration of action up to 24 hours
• Reduces mucus secretion

Triple action: The three mechanisms complement each other: anti-inflammatory action + dual bronchodilation via different pathways.

Trimbow is suitable for:

• Adults with severe asthma (when ICS/LABA is not enough)
• COPD patients with frequent exacerbations
• As a step-up from dual therapy

When to use triple therapy?

• Frequent exacerbations despite ICS/LABA
• Inadequate asthma control on maximum therapy
• COPD GOLD C/D

Not suitable:

• For mild to moderate asthma (overtreatment)
• As first-line therapy
• For children and adolescents under 18 years of age

Trimbow metered-dose inhaler (extrafine):

• 87/5/9 µg (beclometasone/formoterol/glycopyrronium) per puff

Trimbow Nexthaler:

• 88/5/9 µg per single dose

Dosage:

• 2 puffs 2x daily
• Maximum: 4 puffs per day

Note: The extrafine formulation allows lower beclometasone doses with the same efficacy.

Metered-dose inhaler: 1. Remove the protective cap, shake 2. Breathe out deeply 3. Close your lips around the mouthpiece 4. Breathe in slowly and deeply while releasing a puff 5. Hold your breath for 10 seconds 6. Take the second puff the same way 7. Rinse your mouth and spit out

Nexthaler: 1. Open the protective cap 2. Breathe out deeply (not into the inhaler) 3. Close your lips around the mouthpiece 4. Breathe in quickly and deeply 5. Hold your breath 6. Rinse your mouth

Important:

• 2x daily, morning and evening
• Use regularly
• Rinse your mouth

Do not use in case of:

• Hypersensitivity to the active ingredients

Use with caution in case of:

• Narrow-angle glaucoma
• Prostatic hyperplasia
• Severe cardiovascular diseases
• QT prolongation
• Hyperthyroidism
• Diabetes mellitus
• Hypokalemia

Pregnancy: Only if clearly indicated.

Breastfeeding: Weigh benefits against risks.

Common (1-10%):

• Pneumonia in COPD patients
• Oral thrush
• Hoarseness
• Headache
• Urinary tract infections

Uncommon:

• Dry mouth
• Tremor
• Palpitations
• Muscle cramps
• Blurred vision
• Urinary retention

Rare:

• Systemic corticosteroid effects
• Narrow-angle glaucoma
• Paradoxical bronchospasm

Prevention: Rinse your mouth after inhalation.

Interactions:

• CYP3A4 inhibitors – low risk (beclometasone more favorable than fluticasone)
• Beta blockers – can cancel out the effect of formoterol
• Other anticholinergics – additive effect
• QT-prolonging medications
• Potassium-lowering medications

Not recommended:

• Other LABAs or LAMAs at the same time