| Choice | Drug | Dosage |
| Formulary choices (COPD) | Containing Beclometasone/Formoterol | |
| Fostair® MDI 100/6 (Beclometasone/Formoterol) | Dose: 2 inhalations twice daily | |
| Fostair NEXThaler® (DPI) 100/6 (Beclometasone/Formoterol) | Dose: 2 inhalations twice daily | |
Containing Budesonide/formoterol | ||
| DuoResp Spiromax ® (DPI) 160/4.5 320/9 (Budesonide/formoterol) Doses are therapeutically equivalent to Symbicort Turbohaler® 200/6 and 400/12 | Dose: 160/4.5, 2 inhalations twice daily 320/9, 1 inhalation twice daily | |
| Or | ||
| Fobumix® Easyhaler 160/4.5 320/9 (Budesonide/formoterol) Doses are therapeutically equivalent to Symbicort Turbohaler® 200/6 and 400/12 | Dose: 160/4.5, 2 inhalations twice daily 320/9, 1 inhalation twice daily | |
| Or | ||
| Symbicort Turbohaler® 200/6 400/12 (Budesonide/formoterol) | Dose: 200/6, 2 puffs twice daily 400/12, 1 puff twice daily | |
| Symbicort® MDI 200/6 (Budesonide/formoterol) | Dose: 2 puffs twice daily | |
| Reserve for COPD patients using other Ellipta® devices | Containing Fluticasone furoate/ vilanterol | |
Relvar Ellipta®▼ 92/22 (Fluticasone furoate /vilanterol) NB: the 184/22 strength is not licensed for COPD | Dose: In COPD: 1 inhalation once daily |
Prescribing Notes
- 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.
- Prescribers should follow the NICE NG115 guideline on COPD which recommends that inhaled corticosteroids (ICS) should only be used in specific circumstances (e.g. asthmatic features/features suggesting steroid responsiveness) and in a combination inhaler with a long-acting beta-agonist. The choice of drug(s) should take into account the person’s symptomatic response and preference, the drug’s potential to reduce exacerbations, its side effects and cost.
- Information on reviewing and stepping down ‘triple therapy’ in COPD can be found on the PrescQIPP website.
- Prescribers should be aware of the potential risk of developing side effects (including non-fatal pneumonia and possible increased risk of fractures) in people with COPD and be prepared to discuss with patients.
- Patients on high doses of inhaled steroids (more than 1000micrograms/day of beclometasone dipropionate or equivalent) should be given a high dose inhaled corticosteroid safety card and accompanying patient information leaflet.
- 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.
- Three combination ‘triple therapy’ inhalers are now available:
- Trimbow® (beclometasone/formoterol/glycopyrronium) is accepted for use for the maintenance treatment of patients with severe COPD who are not adequately treated by a combination of an ICS and a LABA.
- Trelegy® (fluticasone furoate/vilanterol/umeclidinium) is accepted for use as maintenance treatment in patients with severe COPD who are not adequately treated by a combination of an ICS and a LABA.
- Trixeo Aerosphere® (budesonide/formoterol /glycopyrronium) is accepted for use as maintenance treatment in patients with severe COPD who are not adequately treated by a combination of an ICS and a LABA or combination of a LABA and a LAMA
- These inhalers may offer a more convenient and cost-effective option for patients requiring triple therapy. They should only be prescribed where patient meets criteria for use – refer to relevant Managed Entry Decision for further information