Converting from Pulmicort to Anoro Ellipta in COPD

Patient Selection

The American Thoracic Society recommends that patients with low exacerbation risk and FEV1 >50% predicted should not be on ICS monotherapy and may benefit from switching to LAMA/LABA dual bronchodilator therapy 1
Patients experiencing ICS-related adverse effects without frequent exacerbations may be candidates for this switch, as recommended by the European Respiratory Society 1
Patients with primarily obstructive symptoms without an inflammatory exacerbation phenotype may benefit more from dual bronchodilators than ICS alone, according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2

The European Respiratory Society states that ICS monotherapy should never be used in COPD—ICS should only be combined with long-acting bronchodilators 1
Patients with asthma-COPD overlap syndrome require ICS-containing regimens and should not be switched to bronchodilators alone, as recommended by the European Respiratory Society 3, 4
Patients with blood eosinophil counts ≥300 cells/μL derive significant benefit from ICS and should not have it withdrawn, according to the American College of Chest Physicians 1

The American College of Chest Physicians notes that long-acting muscarinic antagonists are more effective than long-acting β-agonists alone in preventing moderate to severe COPD exacerbations 5

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommends that patients with GOLD Group A (Low symptoms, low exacerbation risk) can be switched directly to Anoro Ellipta 62.5/25 mcg once daily 5
For patients with GOLD Group B (High symptoms, low exacerbation risk), LAMA/LABA dual therapy is preferred over ICS/LABA, as recommended by the European Respiratory Society 3

Withdrawing ICS can increase moderate-severe exacerbation risk, particularly in those with blood eosinophils ≥300 cells/μL, according to the American College of Chest Physicians 1
The American Thoracic Society recommends monitoring for worsening symptoms or increased exacerbation frequency within 4-6 weeks after conversion 1

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommends reintroducing ICS if patient experiences ≥2 moderate-severe exacerbations within 12 months after conversion 1
The European Respiratory Society suggests reintroducing ICS if development of features suggesting asthma-COPD overlap occurs 3

The American College of Chest Physicians recommends adding Anoro to Pulmicort for triple therapy rather than converting, providing ICS + LAMA + LABA coverage for high-risk patients 1
For symptomatic patients with ≥2 exacerbations per year, triple therapy reduces exacerbation rates by 24% compared to LAMA/LABA alone, according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 1