Trimbow (Chiesi Limited) contains beclometasone dipropionate, formoterol fumarate dihydrate and glycopyrronium bromide. Beclometasone dipropionate is an inhaled corticosteroid (ICS), which suppresses inflammation in the lungs; formoterol fumarate dihydrate is a long-acting beta-2 agonist (LABA), which relaxes bronchial smooth muscle in people with reversible airways obstruction; and glycopyrronium bromide is a long-acting muscarinic antagonist (LAMA), which blocks the bronchoconstrictor action of acetylcholine on airway smooth muscle cells, thereby dilating the airways (summary of product characteristics).
Beclometasone/formoterol/glycopyrronium (Trimbow) received a European marketing authorisation in July 2017. It is licensed for maintenance treatment of adults with moderate-to-severe chronic obstructive pulmonary disease (COPD) who are not adequately treated by a combination of an ICS and a LABA (European public assessment report).
According to the summary of product characteristics, each delivered dose of beclometasone/formoterol/glycopyrronium (the dose leaving the mouthpiece) contains 87 micrograms of beclometasone dipropionate, 5 micrograms of formoterol fumarate dihydrate and 9 micrograms of glycopyrronium (as 11 micrograms glycopyrronium bromide). Each metered dose (the dose leaving the valve to be inhaled by the person) contains 100 micrograms of beclometasone dipropionate, 6 micrograms of formoterol fumarate dihydrate and 10 micrograms of glycopyrronium (as 12.5 micrograms glycopyrronium bromide).
The aerosol particles of beclometasone/formoterol/glycopyrronium are extrafine and, on average, much smaller than the particles delivered in non-extrafine formulations. For beclometasone dipropionate, this results in a more potent effect than formulations with a non-extrafine particle size distribution (100 micrograms of beclometasone dipropionate extrafine in Trimbow are equivalent to 250 micrograms of beclometasone dipropionate in a non-extrafine formulation).
The recommended (and maximum) dose of beclometasone/formoterol/glycopyrronium is 2 inhalations twice daily.
A beclometasone/formoterol/glycopyrronium pressurised metered dose inhaler costs £44.50 and provides 120 inhalations (30 days' treatment; cost [excluding VAT] from MIMS, March 2018).