3.2.4 Triple therapy inhalers [COPD]


Choice	Drug	Carbon Footprint	Dose Counter Present (D)
Formulary choices (COPD)	Beclometasone/formoterol/glycopyrronium
		Trimbow® NEXThaler DPI 88/5/9		D
		Or
		Trimbow® MDI 87/5/9 NB - the higher strength MDI 172/5/9 is not licensed for use in COPD		D
		Fluticasone furoate/vilanterol/umeclidinium
		Trelegy® Ellipta DPI 92/55/22		D
		Budesonide/formoterol/glycopyrronium
		Trixeo® Aerosphere MDI 5/7.2/160		D


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)

Triple therapy inhalers may offer a more convenient, cost-effective, lower carbon option for patients requiring triple therapy. They should only be prescribed where patient meets criteria for triple therapy use – refer to NICE NG115 COPD and GOLD report for further guidance.
Trimbow^® MDI (beclometasone / formoterol / glycopyrronium) is also accepted for use as maintenance treatment of asthma, in adults not adequately controlled with a maintenance combination of a long-acting beta-2 agonist and medium dose of inhaled corticosteroid, and who experienced one or more asthma exacerbations in the previous year. For further information see SMC. Please note that both the 172/5/9 and the 87/5/9 strengths of Trimbow^® MDI are licensed for asthma but only the lower strength Trimbow^® 87/5/9 inhaler is licensed for COPD.