Trimbow

What is Trimbow?

Trimbow is a combined prevention and relief inhaler used to treat symptoms of moderate to severe COPD. It’s a type of single inhaler triple therapy, as it contains three active ingredients in one inhaler.

Formoterol belongs to a group of medicines called long-acting beta agonists (LABA), and glycopyrronium is a long-acting muscarinic antagonist (LAMA). These are both types of long-acting bronchodilator, medicines that relax and widen your airways so you can breathe more easily. As they’re long-acting, you’ll feel their effects for about 12 hours.

Beclometasone, on the other hand, is a corticosteroid, which targets and reduces inflammation in your lungs. Together, these should relieve symptoms of COPD and work to prevent them.

How does Trimbow work?

Trimbow’s three active ingredients work in slightly different ways to tackle your COPD.

Formoterol and glycopyrronium are bronchodilators that relax the muscles in your airways, relieving symptoms of COPD. They can be prescribed individually – but if you’ve got moderate or severe COPD, and struggle to control it with a single treatment, taking both can help improve your symptoms. In clinical trials dual therapy has shown to improve lung function, ability to exercise, quality of life, and frequency of flare-ups – slowing down the progression of COPD.^[1]

Beclometasone, on the other hand, inhibits the actions of inflammatory cells in your lungs.^[2]
This reduces irritation and swelling in your airways, and should help prevent your symptoms occurring in the future.

What doses does Trimbow come in?

We currently offer two different types of Trimbow inhaler, but they both contain what amounts to the same dose of medicine. The Trimbow inhaler doses we offer are as follows:

Trimbow metered dose inhalers (MDI) have a delivered dose (the dose that leaves the mouthpiece) of 87 mcg beclometasone, 5 mcg formoterol, and 9 mcg glycopyrronium. They deliver the medication in a pressurised solution that’s released when you activate the inhaler.

Trimbow NEXThalers have a delivered dose of 88 mcg beclometasone, 5 mcg formoterol, and 9 mcg glycopyrronium. NEXThalers are dry powder inhalers (DPI), which contain the medication as a powder that you inhale.

For severe COPD, you can also get Trimbow inhalers containing 172 mcg/5 mcg/9 mcg of beclometasone, formoterol and glycopyrronium respectively. However, we don’t currently offer this dose of Trimbow.

How to use Trimbow

We offer two different kinds of Trimbow inhaler, and how you use it depends on which you have.

How to use Trimbow MDI

You should only use your Trimbow MDI inhaler as your clinician has instructed. The typical dose is two puffs in the morning, and two in the evening. If it’s the first time you’re using your inhaler, you should make sure it’s working properly.

• Make sure that, depending on the size of the inhaler you’re prescribed, the dose counter reads 61, 121, or 180;
• Remove the protective cover from the mouthpiece, and hold the inhaler upright with the mouthpiece at the bottom;
• Point the mouthpiece away and push down firmly on the pressurised canister to release a puff of medicine into the air;
• Check the dose counter. It should have ticked down to 60 or 120 doses from 61 or 121, depending on the size of the inhaler. If your inhaler had 180 doses, the counter should still read 180.

To use your Trimbrow MDI inhaler:

• While standing or sitting upright, remove the protective cap from the mouthpiece. Check that it’s free of dust or dirt;
• Breathe out slowly as far as you can to empty your lungs;
• With the inhaler held vertically and the mouthpiece at the bottom, place the mouthpiece in between your teeth. Make sure you don’t bite down on it, and close your lips around the mouthpiece;
• Take a slow, deep breath in through your mouth to fill your lungs. Just after you start breathing in, push down firmly on top of the pressurised canister to release a puff of medicine;
• Hold your breath for as long as is comfortable;
• Remove the inhaler from your mouth and slowly breathe out. Don’t breathe into the inhaler;
• Check that your dose counter has gone down by one if your inhaler started with 60 or 120 puffs. If it started with 180, check to see if this has rotated a small amount;
• To take a second dose, wait for about half a minute after your first, then repeat from step two;
• Replace the protective cap when you’re finished.

If you see any ‘mist’ escaping from the top of the inhaler or sides of your mouth, start your puff again from step 2. This ensures that you’re getting enough medicine into your lungs to treat your symptoms.

Rinsing your mouth with water or brushing your teeth after using Trimbow helps prevent fungal infections in your mouth and throat.

How to use Trimbow NEXThaler

Only use your Trimbow NEXThaler as instructed by your clinician. The usual dose is two puffs in the morning and two in the evening. Before using your inhaler for the first time, check that it’s working properly:

• Check that the pouch holding your container isn’t damaged. If it is, return it and get a new one;
• Open the pouch and take out the inhaler, noting on the box the date you opened the pouch;
• Check the inhaler isn’t broken or damaged. Return it and get a new one if it is;
• Check that the dose counter reads 120. If it’s lower, return it and get a new inhaler.

To use your Trimbow NEXThaler:

• Hold your inhaler upright, and open the cover on top fully;
• Breathe out as far as is comfortable, away from the inhaler;
• Standing or sitting upright, bring your inhaler to your mouth and place your lips around the mouthpiece. Make sure you’re not covering the air vent;
• Take a deep, forceful breath in through your mouth. You might hear a click or notice a taste in your mouth when taking your dose – these are both normal;
• Take your inhaler out of your mouth, and hold your breath for at least 5 seconds, or as long as is comfortable;
• Breathe out slowly, away from your inhaler;
• If you need to take another dose, wait about 30 seconds, then repeat from step two;
• Close the cover fully over the mouthpiece, and check to make sure the dose counter has gone down.

How long does it take for Trimbow to work?

The different active ingredients in Trimbow will work to relieve your symptoms in the short term, and prevent them long-term.

Formoterol will typically take effect within one to three minutes,^[1]
and glycopyrronium reaches peak levels at around five minutes after your dose.^[2]
As they’re long acting bronchodilators, you should feel their effects on your airways for up to 12 hours after your dose. However, if you find yourself struggling to breathe, you’ll need to use a separate reliever inhaler. Trimbow won’t provide relief from COPD symptoms in the moment.

Beclometasone needs a little longer to take effect; it’ll take around three to seven days before you start noticing its benefits.^[3]
You should find yourself short of breath and wheezing less often, as it works to suppress inflammation in your airways. If you’ve been taking beclometasone for over a week and haven’t noticed any improvement, get in touch with your clinician.

What should I do if I make a mistake taking Trimbow?

You should only use your Trimbow inhaler as your clinician instructs you to. If you’ve forgotten to take a dose of Trimbow, use it as soon as you remember. If your next dose is just around the corner, miss the dose you forgot to take, and take the next one at the correct time. Never take two doses to make up for a missed one.

If you take more Trimbow than you should, it’s unlikely to cause any immediate side effects – especially if it’s just the once. If you do experience any side effects after using too much Trimbow, like a headache or changes to your heart rate, speak with your doctor. If you use too much Trimbow over an extended period of time, you could suffer from adrenal suppression. This is where your adrenal glands don’t produce enough of certain hormones.^[4]