3.2.2 Compound ICS/LABA preparations – [asthma]
(See BNF for MART doses)
100/6: 1 to 2 puffs twice daily; max 4 puffs daily
200/6: 2 puffs twice daily; max 4 puffs daily
|Fostair NEXThaler® (DPI)|
100/6: 1-2 inhalations twice daily; max 4 inhalations daily
200/6: 2 inhalations twice daily; max 4 inhalations daily
DuoResp Spiromax ® (DPI)
Doses are therapeutically equivalent to Symbicort Turbohaler 200/6 and 400/12
160/4.5, 1-2 inhalations twice daily increased if necessary to max 4 inhalations twice daily
320/9, 1 inhalation twice daily increased if necessary to max. 2 inhalations twice daily
Doses are therapeutically equivalent to Symbicort Turbohaler 100/6, 200/6 and 400/12
80/4.5, 160/4.5, 1–2 inhalations twice daily, increased if necessary up to 4 inhalations twice daily
320/9, 1 inhalation twice daily; increased if necessary up to 2 inhalations twice daily.
100/6, 200/6, Initially 1-2 puffs twice daily, increased if necessary up to 4 puffs twice daily; reduced to 1 puff daily, dose reduced only if control is maintained
400/12, Initially 1 puff twice daily, increased if necessary up to 2 puffs twice daily, reduced to 1 puff daily, dose reduced only if control is maintained
Containing Fluticasone propionate/ formoterol
(Fluticasone propionate/ formoterol)
Asthma: 2 puffs twice daily
Containing Fluticasone propionate/ salmeterol
Use a cost-effective combination MDI e.g. AirFluSal®, Sereflo® or Sirdupla®
Refer to BNF for product information
Seretide Accuhaler® (DPI)
(Fluticasone propionate/ Salmeterol)
Asthma: 1 inhalation twice daily
Containing Fluticasone furoate/ vilanterol
Reserve (still uncontrolled and non-adherence suspected)
|Relvar Ellipta®▼ |
Asthma: 1 inhalation once daily
- Certain inhaler devices such those containing beclometasone (+/- formoterol) and dry powder inhalers are not suitable for generic prescribing.
- The device with the lowest acquisition cost should be prescribed which is consistent with the patient’s other inhaler devices and ability to use the device.
- When patients are re-ordering combination inhalers please ensure that another 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 corticosteroid safety card should be given to patients on high doses of inhaled steroids (more than 1000micrograms/day of beclometasone dipropionate or equivalent). Steroid cards and accompanying patient information leaflets can be viewed here.
- See MHRA guidance on safe use of LABAs.
- WIth Fostair®, the beclometasone is an extra fine particle and therefore is more potent than traditional beclometasone dipropionate CFC-free inhalers. When ‘stepping up’ patients with asthma from other beclometasone dipropionate inhalers, Fostair® 100/6 can be prescribed for patients already using beclometasone dipropionate 250 micrograms in another CFC-free inhaler. The dose of Fostair® should be adjusted according to response. Fostair 200/6 should not be used for step-down treatment but rathet a lower strength of the beclometasone dipropionate component in the same inhaler.
- Community pharmacists must store Fostair® MDI in a fridge prior to dispensing. Patients do not need to store Fostair® MDI in a fridge following dispensing, however it can only be stored for a maximum of 5 months once out of the fridge.
- Fostair® MDI contains a small amount of ethanol (approximately 7 mg per actuation), however at normal doses the amount of ethanol is negligible and does not pose a risk to patients.
- Fostair® MDI 100/6, DuoResp Spiromax® 160/4.5 and Symbicort turbohaler® 200/6 are licensed for use as maintenance and reliever (MART) therapy. MART therapy can be considered for adult patients who have a history of asthma attacks on medium dose ICS or ICS/LABA. When this management option is introduced the total regular dose of daily ICS should not be decreased. Patients taking rescue doses of their combination inhaler once a day or more on a regular basis should have their treatment reviewed.
- Most combination inhalers are taken twice daily so please ensure patients taking Relvar Ellipta®▼are aware it is a once daily dose to prevent accidental overdose.
- Trimbow® (beclometasone /formoterol /glycopyrronium) is accepted for use as maintenance treatment of asthma, in adults not adequately controlled with a maintenance combination of a long-acting beta2-agonist and medium dose of inhaled corticosteroid, and who experienced one or more asthma exacerbations in the previous year. For further information see SMC