The Trimbow 87/5/9 inhaler is a fixed triple therapy pMDI. Chiesi makes it. Each puff delivers three active ingredients. Firstly, beclometasone 87 micrograms calms airway swelling. Additionally, formoterol 5 micrograms opens airways within minutes. Furthermore, glycopyrronium 9 micrograms blocks a second tightening signal. As a result, three mechanisms work together in one twice-daily device.
Why extra-fine particles matter
What sets Trimbow apart is the extra-fine particle formulation. The particles measure around 1.5 micrometres across. This is much smaller than standard inhaler droplets. Meanwhile, much of the disease process happens in small airways deep in the lungs. As a result, Trimbow puts more medicine where it needs to work. The European Medicines Agency Trimbow product information covers this in detail.
Who Trimbow 87/5/9 is aimed at
The 87/5/9 strength is the medium-dose ICS Trimbow. For COPD, it’s the primary licensed strength. Additionally, for asthma, it suits adults not controlled on a LABA plus medium-dose ICS combination. Furthermore, if you and your prescriber later decide more steroid is needed, Trimbow 172/5/9 is available as a step up. NICE NG245 recognises this stepwise approach.
Key features and specifications
Active ingredients: beclometasone 87mcg, formoterol 5mcg, glycopyrronium 9mcg per delivered dose
A single inhaler containing three medicines that work through three different mechanisms.
Designed for people who need triple therapy but not the highest available steroid dose.
Delivered through an extra-fine particle mist that reaches deep into the small airways.
Made by Chiesi, the same company behind Fostair.
Prescription only, and often started under specialist review.
Why single-inhaler triple therapy exists
Trimbow answered a specific problem in respiratory care. Before it existed, patients on triple therapy used two or three separate inhalers. As a result, adherence suffered and technique varied. Additionally, outcomes weren’t as good as they could be. A single-device triple therapy sorted that. Peer-reviewed studies confirm the adherence benefit.
The 87/5/9 strength as a starting point
The 87/5/9 strength is the medium ICS option. Its higher-strength sibling, Trimbow 172/5/9, has about double the beclometasone. However, both share the same formoterol and glycopyrronium doses. For COPD, 87/5/9 is the licensed strength. Additionally, it’s often the starting point for asthma triple therapy.
A preventer, not a rescue inhaler
Trimbow isn’t a rescue inhaler. It’s a preventer. As a result, it works quietly in the background. Meanwhile, it reduces airway swelling and keeps airway muscle relaxed. Above all, daily use matters, even on days when you feel fine. Skipping doses lets inflammation creep back.
The device and propellant
Trimbow is a pMDI, or pressurised metered-dose inhaler. Additionally, it’s the standard press-and-breathe type. It uses HFA-134a as the propellant. Notably, this is a modern ozone-friendly gas. Meanwhile, a spacer can help delivery. Ask your prescriber which spacer suits Trimbow.
What to disclose during consultation
Because Trimbow contains glycopyrronium, it needs extra care in some situations. Firstly, narrow-angle glaucoma matters. Additionally, an enlarged prostate is relevant. Furthermore, certain heart rhythm problems should be mentioned. None of these automatically rule Trimbow out. However, they need discussion.
Why choose Courier Pharmacy for your Trimbow 87/5/9 inhaler
Registered, independent, and patient-led
Courier Pharmacy is a UK-registered independent pharmacy. The General Pharmaceutical Council regulates us. Firstly, respiratory disease looks different for every patient. Additionally, your triggers, history, and device preferences all matter. As a result, our prescribers ask about those things. Getting Trimbow right is about the fit.
Dr Ada Jex-Cori, our brand pharmacist
Our brand pharmacist is Dr Ada Jex-Cori. She represents the spirit of what we do. Named for Ada Lovelace, Sophia Jex-Blake, and Gerty Cori, she stands for evidence-led, unafraid-of-questions medicine. Her message is straightforward. You’re not broken. The system is. We’re here to change that.
Care that keeps showing up
We don’t disappear after we’ve dispensed. Furthermore, if your control shifts, we’re here. Additionally, if a side effect appears, we help you make sense of it. For patients navigating MCAS or chronic fatigue alongside respiratory care, that continuity matters. Care that fits means care that keeps showing up.
Buy Trimbow 87/5/9 inhaler (Prescription Only) from Courier Pharmacy
The Trimbow 87/5/9 inhaler is a Prescription Only Medicine. You can request it at courierpharmacy.co.uk. Firstly, complete an online consultation. Then, a UK-qualified prescriber reviews your answers. If approved, we dispense and deliver discreetly.
Complete a quick online consultation
A UK prescriber reviews your answers
If approved, a prescription is issued
We dispense and deliver discreetly to your door
If it isn’t suitable for you, we’ll explain why and suggest the next best option.
Active ingredient in Trimbow 87/5/9 inhaler
Three medicines in one puff
Trimbow 87/5/9 contains three active ingredients per dose. Firstly, beclometasone dipropionate 87 micrograms is an inhaled steroid. Additionally, formoterol fumarate 5 micrograms is a long-acting reliever. Furthermore, glycopyrronium 9 micrograms is a long-acting muscle-relaxer. As a result, three mechanisms work together in one device. The Trimbow Summary of Product Characteristics lists these doses.
Other ingredients
The three medicines sit in an ethanol-based solution. Meanwhile, HFA-134a propellant delivers each dose. Notably, each puff also contains 8.856 mg of ethanol. This is a small amount and rarely clinically significant. However, mention any concerns during your consultation.
What is Trimbow 87/5/9 for?
Licensed for moderate-to-severe COPD
Trimbow 87/5/9 is licensed for moderate-to-severe COPD in adults. In particular, it suits patients not controlled on ICS plus LABA or LABA plus LAMA. Additionally, COPD is the primary indication for this strength. Above all, it addresses the different pathways driving COPD. NICE NG115 for COPD recognises triple therapy for this group.
Licensed for asthma not controlled on dual therapy
Trimbow 87/5/9 is also licensed for asthma in adults. Meanwhile, it suits adults not controlled on a LABA and medium-dose ICS combination. Additionally, patients must have had at least one flare-up in the past year. As a result, it addresses ongoing symptoms after dual therapy hasn't held.
Where it fits in the treatment ladder
In practical terms, Trimbow 87/5/9 is often the starting point for triple therapy. If your current preventer isn't holding, this is one route forward. Furthermore, NICE NG245 for asthma recognises triple therapy as an appropriate next step. However, it isn't licensed for under-18s.
How does Trimbow 87/5/9 work?
Beclometasone calms the swelling
Beclometasone binds to steroid receptors in airway cells. Firstly, this switches off genes that produce inflammatory chemicals. As a result, airway swelling reduces over 1 to 2 weeks. Additionally, the airways become less twitchy. Think of it as turning down the alarm system in your airways.
Formoterol opens the airways fast
Formoterol activates beta-2 receptors on airway smooth muscle. Meanwhile, the signal tells the muscle to relax. As a result, the airways open within 1 to 3 minutes. Additionally, the effect lasts 12 hours. In contrast to salmeterol, formoterol works fast and lasts long.
Glycopyrronium blocks a second signal
Glycopyrronium blocks muscarinic receptors on the same airway muscle. Firstly, these receptors respond to acetylcholine. Meanwhile, acetylcholine tells the muscle to tighten. As a result, blocking this signal removes a second tightening pathway. Formoterol cannot reach this pathway on its own. It also helps to reduce the mucus production.
Why extra-fine particles matter
The extra-fine particles matter for how Trimbow reaches the lungs. In both asthma and COPD, much of the disease is in small airways. However, standard-particle inhalers deposit most medicine higher up. Meanwhile, Trimbow's smaller particles reach further. As a result, more medicine lands where inflammation actually is.
How long until you feel the full effect
You'll feel the bronchodilator effect within hours of the first dose. However, the full anti-inflammatory benefit takes 1 to 2 weeks. Furthermore, the combined benefit of triple therapy shows within 4 to 6 weeks. That's why sticking with twice-daily use matters. Above all, take it even when you feel well.
How to use Trimbow 87/5/9 inhaler
Step-by-step technique
Take 2 inhalations twice a day, morning and evening. Firstly, shake the inhaler before each use. Then, breathe out fully. Next, put the mouthpiece between your teeth with lips closed. Now start to breathe in slowly and press the top at the same time. Hold your breath for 10 seconds if you can. The NHS provides an inhaler technique guide.
Mouth care after use
Rinse your mouth and spit afterwards, or brush your teeth. Additionally, inhaled steroids can cause oral thrush or hoarseness. Meanwhile, rinsing removes any medicine that hasn't reached your lungs. Furthermore, using a spacer improves delivery and reduces mouth side effects. Ask your prescriber which spacer suits Trimbow.
Missed doses and storage
If you miss a dose, take it as soon as you remember. However, if it's nearly time for your next dose, skip the missed one. Never double up. Additionally, store the canister below 50 degrees Celsius. Never pierce or burn it, even when empty.
Treatment dosage Trimbow 87/5/9
Standard adult dose
The recommended and maximum dose is 2 inhalations twice daily. Additionally, take one dose in the morning and one in the evening. This makes 4 puffs a day in total. However, do not exceed this. The BNF and Trimbow Summary of Product Characteristics both confirm this schedule.
Trimbow is a preventer, not a reliever
Trimbow is a maintenance inhaler. As a result, take it every day, even when you feel well. It isn't a reliever. Furthermore, it won't work fast enough in an asthma attack. Meanwhile, always keep a short-acting reliever like salbutamol with you. NICE NG245 makes this point clearly.
Licensing and switching
Trimbow 87/5/9 isn't licensed for children or adolescents under 18. Additionally, it's not for use as a rescue inhaler. If you're moving up from a different combination, your prescriber will guide the changeover. This ensures your steroid dose lines up correctly.
Warnings and precautions for Trimbow 87/5/9 inhaler
Who should not use it
Firstly, don't use Trimbow if you're allergic to any of the ingredients. Additionally, tell your prescriber about heart disease or irregular heartbeat. Similarly, mention high blood pressure, diabetes, or thyroid problems. Furthermore, disclose narrow-angle glaucoma or an enlarged prostate. These need extra care with Trimbow.
Cardiovascular and eye considerations
Formoterol can slightly raise heart rate and blood pressure. However, palpitations are uncommon. Meanwhile, glycopyrronium needs care in narrow-angle glaucoma. Additionally, contact your prescriber for eye pain or coloured halos around lights. As a result, disclose any glaucoma history during consultation.
Paradoxical bronchospasm
Very rarely, inhalers cause paradoxical bronchospasm. This is when airways tighten straight after use. Firstly, if this happens, stop Trimbow and use your reliever. Additionally, contact your prescriber urgently. Above all, don't continue with the same inhaler until reviewed.
Adrenal function and pregnancy
Inhaled steroids can rarely affect the body's natural steroid production. However, this is less of a concern at the 87 microgram strength than at 172. Meanwhile, pregnancy and breastfeeding need discussion. Animal studies have shown effects at high doses. As a result, mention any of these during consultation.
Ethanol content and driving
Notably, Trimbow contains 8.856 mg of ethanol per puff. This is a small amount. However, mention concerns during consultation. Above all, Trimbow has no or negligible influence on driving or machinery use.
Side effects of Trimbow 87/5/9 inhaler
Common side effects
The most common side effects affect up to 1 in 10 people. These include sore throat, hoarse voice, and cough. Additionally, dry mouth, oral thrush, and muscle cramps can occur. Meanwhile, headache and urinary tract infection are also common. Most are manageable with good technique and mouth care.
Uncommon side effects
Uncommon side effects (up to 1 in 100) include flu-like symptoms and sinus problems. Furthermore, tremor, dizziness, and palpitations can occur. Additionally, facial flushing and blood test changes are possible. Your prescriber may check blood tests if needed.
Rare and very rare side effects
Rare side effects (up to 1 in 1,000) include chest pain and paradoxical bronchospasm. Additionally, pneumonia can occur in COPD patients. Very rare side effects (up to 1 in 10,000) include serious allergic reactions and adrenal effects. Above all, any of these need urgent attention.
When to seek urgent help
Seek urgent help for sudden worsening breathlessness after a puff. Similarly, seek help for facial swelling or difficulty breathing. Additionally, get help for severe chest pain or an irregular heartbeat. Meanwhile, sudden eye pain with blurred vision needs immediate attention.
Yellow Card reporting
You can report any suspected side effects directly via the MHRA Yellow Card Scheme at https://yellowcard.mhra.gov.uk. Reporting side effects helps provide more information on the safety of this medicine.
Drug interactions with Trimbow 87/5/9 inhaler
Beta-blockers and other airway medicines
Firstly, beta-blockers can reduce or block the formoterol effect. This includes some glaucoma eye drops. Additionally, other beta-2 agonists can add up to more side effects. Meanwhile, other anticholinergic inhalers like ipratropium should be avoided. Tell your prescriber about any of these.
Medicines affecting potassium
Meanwhile, diuretics that lower potassium can interact. In particular, loop and thiazide types matter. Additionally, digoxin and xanthines like theophylline deserve mention. Furthermore, other steroids can add to systemic effects. These combinations need careful review.
CYP3A4 inhibitors and QT-affecting medicines
Strong CYP3A4 inhibitors can raise beclometasone levels. Firstly, this includes ketoconazole, itraconazole, and ritonavir. Additionally, clarithromycin and telithromycin matter. Meanwhile, Trimbow can rarely affect heart rhythm. As a result, avoid combining with certain antiarrhythmics or MAOIs.
Surgery and diabetes
Firstly, mention Trimbow if you're due surgery. Some anaesthetics interact with formoterol. Additionally, formoterol can raise blood sugar. Meanwhile, if you have diabetes, monitoring may need tightening. Above all, tell your prescriber about all medicines you take.
Frequently asked questions about Trimbow 87/5/9 inhaler
How quickly does Trimbow 87/5/9 start working?
Formoterol opens your airways within 1 to 3 minutes. Additionally, glycopyrronium builds over the first day. However, the full anti-inflammatory benefit takes 1 to 2 weeks. The combined triple therapy benefit shows within 4 to 6 weeks.
Can I use Trimbow 87/5/9 as a rescue inhaler?
No. Trimbow is a maintenance preventer. As a result, it won't work fast enough in an asthma attack. Always keep a short-acting reliever with you. If you're using your reliever more than 3 times a week, contact your prescriber.
Why do I need to rinse my mouth after every use?
Inhaled steroids can cause oral thrush, hoarseness, or a sore throat. As a result, rinsing removes medicine that didn't reach your lungs. Additionally, it prevents a common side effect. Don't swallow the rinse water.
Do I need a spacer with Trimbow 87/5/9?
A spacer isn't essential, but it can help. Firstly, it improves lung delivery. Additionally, it reduces mouth and throat side effects. However, Trimbow is a solution, not a suspension. As a result, not every spacer suits it. Ask your prescriber.
Can I stop Trimbow if I feel well?
No. Trimbow is a preventer. It works because you take it every day. As a result, stopping it lets inflammation come back. Speak to your prescriber before changing your treatment. Any step-down should be planned.
What's the difference between 87/5/9 and 172/5/9?
Both share the same formoterol and glycopyrronium doses. However, they differ in beclometasone. Trimbow 87/5/9 delivers a medium steroid dose. Meanwhile, 172/5/9 delivers a high steroid dose. Additionally, 87/5/9 is often the starting strength for triple therapy.
What if 87/5/9 doesn't control my symptoms?
If Trimbow 87/5/9 doesn't deliver enough control, your prescriber may step you up. In particular, Trimbow 172/5/9 has about double the beclometasone. Furthermore, this is a considered clinical decision, not a failure. Discuss any ongoing symptoms with your prescriber.
Why is Trimbow often called specialist-initiated?
On many NHS formularies, Trimbow sits on the amber or grey list. Additionally, this means it's usually started under specialist care. Furthermore, it reflects its position as a considered step up. Above all, it deserves careful assessment before starting.
How does Trimbow compare to Trelegy Ellipta?
Both are triple therapy inhalers. However, Trelegy is a once-daily dry powder inhaler. Meanwhile, Trimbow is a twice-daily pressurised inhaler with extra-fine particles. Additionally, they use different molecules. Choice comes down to device and clinical response.
Can I use Trimbow if I have both asthma and COPD?
Yes. Trimbow is licensed for both. Additionally, this makes it useful for asthma-COPD overlap. Your prescriber will assess whether Trimbow suits your combined picture. Above all, disclose both diagnoses during consultation.
Will Trimbow 87/5/9 affect my heart?
Formoterol can slightly increase heart rate and blood pressure. Meanwhile, palpitations are uncommon. However, most people tolerate Trimbow well. Above all, tell your prescriber about any existing heart conditions before starting.
Can Trimbow make me hoarse?
Yes. Hoarseness is a common side effect of inhaled steroids. Above all, it usually settles as your voice adjusts. Additionally, rinsing your mouth after use reduces the risk. If it persists, tell your prescriber.
Can I use Trimbow if I have glaucoma?
Glycopyrronium needs care in narrow-angle glaucoma. Firstly, tell your prescriber if you have any glaucoma. Additionally, contact them immediately for eye pain or coloured halos around lights. Above all, disclose your eye pressure history.
Can I use Trimbow if I have prostate problems?
Glycopyrronium can worsen urinary retention. In particular, this matters for older men with an enlarged prostate. Furthermore, tell your prescriber about any difficulty passing urine before starting. Contact them if urinary symptoms worsen.
Can I use Trimbow during pregnancy?
Only after careful discussion. Animal studies have shown effects at high doses. Additionally, there's limited data on Trimbow in human pregnancy. If you're pregnant, planning pregnancy, or breastfeeding, tell your prescriber.
Does the ethanol content matter?
Each puff contains 8.856 mg of ethanol. Notably, this is a very small amount. As a result, it's rarely clinically significant. However, mention any specific concerns during consultation.
What happens if I miss a dose?
Take the missed dose as soon as you remember. However, if it's nearly time for the next dose, skip it. Never double up. Consistency over weeks matters more than any single missed puff.
Can I use Trimbow with other inhalers?
Only if your prescriber has agreed the combination. Firstly, some inhalers duplicate what Trimbow provides. Additionally, other LAMA inhalers like Spiriva overlap. However, a short-acting reliever like salbutamol is generally fine alongside Trimbow.
Will I need a prescription from Courier Pharmacy?
Yes. Trimbow is a Prescription Only Medicine. A UK-qualified prescriber must review your suitability. You can complete the consultation at courierpharmacy.co.uk.
What if Trimbow 87/5/9 isn't right for me?
Sometimes another Trimbow strength suits better. In other cases, a different combination is the answer. Whatever the situation, we'll explain why and suggest the next best option. Honesty over sales, every time.
More than a prescription: our community
Free fortnightly drop-in clinics in Derby
Healthcare shouldn't only happen when you're paying for it. Every fortnight, we run free drop-in talks at Insomnia, Derby, from 10 am to 12 pm. Anyone can come. No appointment. No cost. No pressure.
Topics we cover
We cover asthma control and inhaler technique. Additionally, we discuss weight management and hormone health. Furthermore, we cover MCAS, chronic fatigue, and more. Learn more about our community talks at courierpharmacy.co.uk.
Disclaimer
Disclaimer: This information is for education only and isn't a substitute for personal medical advice. Always follow your prescriber's instructions.
Electronic Medicines Compendium (2024) Trimbow pMDI 87 micrograms/5 micrograms/9 micrograms pressurised inhalation, solution: Patient Information Leaflet. Available at: https://www.medicines.org.uk/emc/product/761/pil
National Institute for Health and Care Excellence (2019) Chronic obstructive pulmonary disease in over 16s: diagnosis and management. NICE guideline NG115. Available at: https://www.nice.org.uk/guidance/ng115
National Institute for Health and Care Excellence (2024) Asthma: diagnosis, monitoring and chronic asthma management. NICE guideline NG245. Available at: https://www.nice.org.uk/guidance/ng245
