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Home Formulary 3.0 Respiratory System 3.2 Corticosteroids 3.2.2 Compound ICS/LABA preparations – [asthma]

3.2.2 Compound ICS/LABA preparations – [asthma]

Prescribe an inhaler with a lower carbon impact where possible – resources can be found here.

ChoiceDrugCarbon FootprintDose Counter Present (D)MART licence *
Formulary choices









Beclometasone/formoterol

Fostair NEXThaler® DPI
100/6, 200/6

D

100/6 - Yes

200/6 - No

If MDI is required

Luforbec® MDI -cost effective choice

100/6, 200/6

D

100/6 - Yes

200/6 - No

Or
Fostair® MDI 100/6, 200/6

D

100/6 - Yes

200/6 - No

Budesonide/formoterol

Fobumix® Easyhaler DPI -cost effective choice

80/4.5, 160/4.5, 320/9

Doses are therapeutically equivalent to Symbicort Turbohaler 100/6, 200/6 and 400/12

D

80/4.5 - Yes

160/4.5 - Yes

320/9 - No

Or

DuoResp Spiromax ® DPI 160/4.5, 320/9

Doses are therapeutically equivalent to Symbicort Turbohaler 200/6 and 400/12

D

160/4.5 - Yes

320/9 - No

Or
Symbicort Turbohaler® DPI 100/6, 200/6, 400/12

D

100/6 - Yes

200/6 - Yes and licensed as reliever in mild asthma

400/12 - No

Fluticasone propionate/salmeterol

Fixkoh Airmaster® DPI -cost effective choice

 100/50, 250/50, 500/50

Or

DNo

Seretide Accuhaler® DPI 100/50, 250/50, 500/50

Or

If MDI is required use a cost effective combination  

 

e.g. Combisal® or Avenor®

 

D

No

 

 

No

Fluticasone furoate/ vilanterol

Relvar Ellipta® DPI 92/22, 184/22

DNo
* licenses correct at time of NI Formulary Chapter publication. Refer to product literature for most up to date information.
Symbol Carbon indicator

Low Carbon Footprint (<2kg CO2e per inhaler)

High Carbon Footprint (6-20kg CO2e per inhaler)

Highest Carbon Footprint (>34kg CO2e per inhaler)

Prescribing Notes

  • Specify brand and inhaler device when prescribing to help reduce confusion and ensure patients receive the inhaler they have been trained to use.
  • Offer dry powder inhalers (DPIs) as first choice when clinically appropriate. If MDIs are needed then chose brand and regime with care to minimise carbon footprint – resources to support choice can be found here.
  • Fostair® and Luforbec® contain extra-fine particles of beclometasone dipropionate and are more potent than traditional beclometasone dipropionate CFC-free inhalers. 100 micrograms of beclometasone dipropionate extra-fine is equivalent to 250 micrograms of beclometasone dipropionate in a non-extra-fine formulation. When switching from non-extra-fine formulations the dose should be reduced and adjusted according to response.
  • Most combination inhalers are taken twice daily so ensure patients taking Relvar Ellipta® are aware it is a once daily dose to prevent incorrect dosing.
  • When patients are re-ordering combination inhalers, ensure that a prescription is due. The compliance ready reckoner indicates how long the inhaler should last.
  • Before initiating a new drug therapy practitioners should recheck adherence, inhaler technique and eliminate trigger factors.
  • A Steroid Emergency Card should be given to patients on high doses of inhaled steroids [more than 1000 micrograms/day of standard (not extra-fine) beclometasone dipropionate or equivalent]. RightBreathe gives inhaler specific advice on whether a steroid safety card is needed and SIGN 158 categorises inhaled steroids by dose (low, medium and high). Use of other corticosteroid therapy or concurrent use of drugs which inhibit corticosteroid metabolism should also be taken in to account when assessing systemic risk. Community pharmacies and GP practices can order these from pharmacystationeryorders@hscni.net
  • See MHRA guidance on safe use of LABAs.

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