Eklira

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Eklira on Prescriptsy

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Eklira Genuair is a prescription-only inhaler containing aclidinium bromide, a long-acting muscarinic antagonist (LAMA) used as maintenance bronchodilator treatment for chronic obstructive pulmonary disease (COPD) in adults.

It is delivered via the Genuair device, a breath-actuated dry powder inhaler designed for ease of use. Each actuation delivers 322 micrograms of aclidinium bromide.

Eklira is taken twice daily to help keep the airways open, reduce breathlessness, and improve the ability to carry out daily activities.

COPD is a major cause of morbidity and mortality in the United Kingdom, affecting an estimated 1.2 million diagnosed individuals and many more who remain undiagnosed.

It encompasses chronic bronchitis and emphysema, both characterised by progressive, largely irreversible airflow limitation caused predominantly by smoking.

Symptoms include persistent breathlessness on exertion, chronic cough, sputum production, wheezing, and reduced exercise tolerance.

COPD tends to worsen over time and is punctuated by exacerbations (acute flare-ups) that accelerate lung function decline and impair quality of life.

Maintenance bronchodilator therapy is a cornerstone of COPD management, and long-acting muscarinic antagonists such as aclidinium play a central role.

This page provides a comprehensive clinical overview of Eklira Genuair, covering how it works, who it is suitable for, how to use the inhaler correctly, expected benefits, side effects, important warnings, and how to obtain it in the UK.

Important safety information about Eklira Genuair

Before reading further, note the following essential safety points. Eklira is a prescription-only medicine (POM) for COPD maintenance only.

• Eklira is not a rescue inhaler. Do not use it to treat sudden breathlessness or a COPD exacerbation. Always carry a short-acting reliever inhaler (such as salbutamol) for acute symptoms.
• Do not use Eklira if you have a known allergy to aclidinium, atropine, or any atropine-related medicine.
• Use with caution if you have narrow-angle glaucoma or urinary retention (particularly men with benign prostatic hyperplasia).
• Seek immediate medical attention if you experience sudden worsening of breathing after inhalation, eye pain, or inability to pass urine.

Understanding COPD

Chronic obstructive pulmonary disease is caused by long-term damage to the lungs, most commonly from cigarette smoking.

Occupational exposure to dust, chemicals, and fumes, as well as indoor air pollution (particularly biomass fuel combustion in developing countries) and alpha-1 antitrypsin deficiency (a rare genetic condition), are other recognised causes.

The damage leads to two overlapping pathological processes.

Chronic bronchitis involves inflammation and narrowing of the small airways (bronchioles), with increased mucus production. This causes chronic cough and sputum production, often worst in the morning.

Emphysema involves destruction of the alveolar walls (the tiny air sacs where gas exchange occurs), reducing the surface area available for oxygen transfer and trapping air in the lungs (hyperinflation).

The combined effect is progressive airflow limitation that worsens over years and does not fully reverse with bronchodilator treatment, distinguishing COPD from asthma.

COPD is classified by severity using spirometry (a breathing test measuring forced expiratory volume in one second, or FEV1) in accordance with NICE guideline NG115 and the Global Initiative for Chronic Obstructive Lung Disease (GOLD) framework.

Treatment is stepped up based on severity, symptom burden, and exacerbation frequency. Long-acting bronchodilators are recommended from GOLD group B onwards (moderate symptoms or frequent exacerbations).

How Eklira works: mechanism of action

The airways are regulated by the autonomic nervous system.

The parasympathetic nervous system, acting through the neurotransmitter acetylcholine and muscarinic receptors (principally M3 subtype) on airway smooth muscle, promotes bronchoconstriction and mucus secretion.

In COPD, parasympathetic (cholinergic) tone is often increased, contributing to persistent airway narrowing, excess mucus, and air trapping.

Aclidinium bromide is a potent, selective antagonist of M3 muscarinic receptors.

By blocking acetylcholine from binding to these receptors on airway smooth muscle, aclidinium produces sustained relaxation and widening of the airways (bronchodilation). It also reduces mucus hypersecretion.

The result is improved airflow, reduced breathlessness, and better exercise tolerance.

Aclidinium has two notable pharmacological properties that distinguish it from some other LAMAs.

First, it has a relatively rapid onset of action, producing clinically meaningful bronchodilation within approximately 30 minutes of inhalation, which many patients appreciate.

Second, it is rapidly hydrolysed to inactive metabolites in plasma (plasma half-life of parent compound approximately 2 to 3 minutes), resulting in very low systemic exposure.

This rapid inactivation is believed to contribute to its favourable tolerability profile, particularly with respect to cardiovascular and anticholinergic side effects.

Clinical evidence and UK prescribing guidance

Aclidinium's efficacy and safety have been demonstrated in the ATTAIN, ACCORD, and AUGMENT clinical trial programmes, involving thousands of patients with moderate to severe COPD.

These studies showed that aclidinium 322 micrograms twice daily produced statistically significant and clinically meaningful improvements in trough FEV1 (the key measure of sustained bronchodilation), peak FEV1, COPD symptom scores, and health-related quality of life (measured by the St George's Respiratory Questionnaire) compared with placebo.

The AUGMENT study additionally demonstrated that the combination of aclidinium with formoterol (a LABA) provided greater bronchodilation than either component alone, supporting the use of dual bronchodilator therapy in patients with more severe symptoms or inadequate response to monotherapy.

NICE guideline NG115 on COPD management recommends offering a long-acting muscarinic antagonist (LAMA), a long-acting beta-2 agonist (LABA), or a LAMA combined with a LABA to patients with persistent breathlessness or exacerbations despite short-acting bronchodilator use.

The choice between specific LAMAs (aclidinium, tiotropium, glycopyrronium, umeclidinium) depends on patient preference, device suitability, dosing frequency, cost, and local formulary guidance.

Aclidinium's twice-daily dosing may be preferred by patients who also take other twice-daily medications, while its rapid onset of action is appreciated by patients who value prompt symptom relief.

The Genuair inhaler device

The Genuair is a multidose, breath-actuated dry powder inhaler designed for simplicity and reliability.

Unlike pressurised metered-dose inhalers (pMDIs), it does not require hand-breath coordination, as the dose is released automatically when the patient inhales with sufficient force.

This is particularly beneficial for elderly COPD patients or those with reduced dexterity.

Key features of the Genuair include a coloured control window that changes from green (dose loaded) to red (dose delivered), providing visual confirmation that the inhalation was successful.

An audible click also confirms dose delivery. A dose counter shows the number of remaining doses, and a red band appears when approximately 10 doses remain.

The device locks when all 60 doses have been used, preventing attempted use of an empty inhaler.

Correct inhaler technique is critical for effective drug delivery to the lungs.

Studies consistently show that poor technique is one of the most common reasons for inadequate COPD symptom control.

The Genuair's feedback mechanisms (visual and auditory) help patients confirm correct use, and healthcare professionals should demonstrate and check technique at every review.

How to use Eklira Genuair correctly

Step 1: Remove the protective cap by squeezing the arrows on each side and pulling.

Step 2: Hold the inhaler horizontally with the mouthpiece towards you and the coloured button facing upwards.

Do not hold the inhaler vertically, as this may prevent correct dose loading. Step 3: Press the coloured button all the way down, then release it completely.

The control window will change from red to green, indicating the dose is loaded.

Do not press the button again, and do not tilt the inhaler until you are ready to inhale. Step 4: Breathe out fully, away from the inhaler.

Do not breathe into the mouthpiece. Step 5: Place your lips firmly around the mouthpiece, ensuring a good seal. Breathe in strongly and deeply through your mouth.

You will hear a click and the control window will change from green to red, confirming the dose has been inhaled.

Step 6: Remove the inhaler from your mouth and hold your breath for 5 to 10 seconds, or as long as is comfortable.

Step 7: Breathe out slowly and gently through your nose. Step 8: Replace the protective cap.

If the control window remains green after inhalation, the dose may not have been delivered. Check your technique, particularly that you breathed in forcefully enough, and try again.

If problems persist, ask your pharmacist, practice nurse, or respiratory team for a technique check.

Side effects of Eklira Genuair

Common side effects

Common side effects include headache, nasopharyngitis, cough, and diarrhoea. Sinusitis is also reported commonly. These effects are generally mild and do not usually require stopping treatment.

Uncommon and rare side effects

Uncommon effects include dry mouth, blurred vision, tachycardia, palpitations, hoarseness (dysphonia), nausea, oral candidiasis (oral thrush), urinary retention, dizziness, and muscle pain.

Dry mouth is a recognised anticholinergic effect but occurs less frequently with aclidinium than with some other LAMAs.

Rinsing the mouth with water after each inhalation can help prevent dry mouth and oral thrush.

Rare but important effects include narrow-angle glaucoma (eye pain, visual halos, red eye), severe hypersensitivity reactions (rash, angioedema, anaphylaxis), and paradoxical bronchospasm (sudden worsening of breathing immediately after inhalation).

Paradoxical bronchospasm is an emergency: stop using Eklira, use your short-acting reliever inhaler, and seek immediate medical help.

When to seek urgent medical advice

Seek emergency medical care (call 999 or attend A&E) if you experience sudden severe worsening of breathing after using the inhaler, signs of severe allergic reaction (facial swelling, throat tightness, breathing difficulty, widespread rash), or eye pain with visual disturbance (possible acute glaucoma).

Contact your GP or NHS 111 for persistent dry mouth, voice changes, difficulty urinating, or any new symptoms.

Report any adverse reactions to the MHRA via the Yellow Card scheme at yellowcard.mhra.gov.uk .

Warnings and precautions

Not for acute relief

Eklira Genuair is a maintenance bronchodilator. It must not be used as a rescue inhaler for sudden breathlessness.

If your need for your short-acting reliever inhaler increases, or if your usual dose of reliever is not providing adequate relief, this may indicate worsening COPD.

Contact your GP or respiratory team promptly.

Glaucoma

Anticholinergic medicines can raise intraocular pressure and precipitate or worsen narrow-angle (closed-angle) glaucoma. If you have narrow-angle glaucoma, discuss the risk with your prescriber before starting Eklira.

Avoid letting the inhaled powder contact your eyes. Seek immediate ophthalmological assessment if you develop eye pain, blurred vision, visual halos, or red eyes during treatment.

Urinary retention

Anticholinergic medicines can worsen urinary retention, particularly in men with pre-existing benign prostatic hyperplasia. If you develop difficulty passing urine, a weak urinary stream, or a feeling of incomplete bladder emptying, stop Eklira and seek medical advice.

Cardiovascular caution

Patients with unstable heart disease, recent myocardial infarction, arrhythmias (other than stable chronic atrial fibrillation), or prolonged QTc interval were excluded from clinical trials. Use Eklira with caution in these groups and discuss the risks with your prescriber.

Dental health

Long-term dry mouth from anticholinergic treatment may increase the risk of dental caries. Maintain good oral hygiene, rinse your mouth with water after using the inhaler, and attend regular dental check-ups.

Eklira compared with other COPD maintenance inhalers

Several other LAMAs are available in the UK for COPD maintenance, including tiotropium (Spiriva), glycopyrronium (Seebri), and umeclidinium (Incruse). All are effective bronchodilators with broadly similar efficacy.

Key differences include dosing frequency (aclidinium is twice daily; tiotropium, glycopyrronium, and umeclidinium are once daily), device type, onset speed (aclidinium has a relatively rapid onset), and cost.

The choice depends on patient preference, inhaler technique, comorbidities, and local prescribing guidance.

For patients requiring dual bronchodilation (LAMA plus LABA), the combination product Duaklir Genuair (aclidinium/formoterol) provides both in a single device. Triple therapy (LAMA plus LABA plus inhaled corticosteroid) may be required for patients with frequent exacerbations despite dual bronchodilator use.

How to get Eklira Genuair in the UK

Eklira is a prescription-only medicine available on the NHS.

Your GP, practice nurse with prescribing authority, or respiratory specialist can prescribe it following clinical assessment, including spirometry to confirm the COPD diagnosis and assess severity.

Authorised online prescribers registered with the GPhC may also prescribe Eklira following a structured respiratory consultation.

The standard NHS prescription charge in England is currently 9.90 pounds per item; prescriptions are free in Scotland, Wales, and Northern Ireland.

Living with COPD: practical advice

Stopping smoking is the single most important intervention to slow COPD progression. NHS Stop Smoking services provide free support and pharmacotherapy (nicotine replacement, varenicline).

Pulmonary rehabilitation, a structured programme of exercise and education, is strongly recommended for all COPD patients with functional limitation and is available through the NHS.

Annual influenza vaccination and pneumococcal vaccination are recommended. Regular physical activity, even at low intensity, helps maintain muscle strength and cardiovascular fitness.

A self-management plan, developed with your healthcare team, helps you recognise and respond to exacerbations early, including when to start rescue antibiotics and oral corticosteroids.

When to seek urgent medical advice

Contact your GP or NHS 111 if your COPD symptoms are worsening (increasing breathlessness, more frequent cough, change in sputum colour or volume), if you are needing your reliever inhaler more often, or if you develop new symptoms such as ankle swelling (which may indicate heart problems associated with severe COPD).

Call 999 or attend A&E if you experience severe breathlessness at rest, confusion, a bluish tinge to the lips or fingers (cyanosis), or chest pain.

Report any adverse reactions to Eklira via the MHRA Yellow Card scheme at yellowcard.mhra.gov.uk .

Sources

• Eklira Genuair 322 micrograms Inhalation Powder, Summary of Product Characteristics (EMC)
• Aclidinium bromide, British National Formulary (BNF)
• NICE NG115: Chronic obstructive pulmonary disease in over 16s: diagnosis and management
• Chronic obstructive pulmonary disease (COPD), NHS
• Global Initiative for Chronic Obstructive Lung Disease (GOLD)
• MHRA Yellow Card Scheme