NHS Greater Glasgow & Clyde Area Drug and Therapeutics Committee
Greater Glasgow and Clyde Medicines
Medicines Update

Asthma / COPD Inhalers of Choice

The ADTC has agreed recommendations from Respiratory MCN Prescribing Subgroup review of the asthma and COPD sections of the Adult Formulary for bronchodilators and corticosteroids. This should be considered when making prescribing decisions when therapy is being reviewed. Prescribing notes and supporting material to assist with inhaler device choice is being produced and will be circulated widely once finalised.

 

The 2013 inhaler identification guide for Acute is due to be updated, but the existing version is here.

 

In 2014/2015 NHSGGC costs for respiratory drugs were around £32million (£31million in primary care; £1m in acute care). Spiriva®, Seretide®, Symbicort®, budesonide and fluticasone inhalers accounted for £21million of the spend.

 

The main changes from the review include:

 

 All inhalers should be prescribed by brand, with the exception of salbutamol MDI. This will reduce the risk of incorrect products being prescribed or dispensed. Note that different brands of beclometasone CFC-free inhalers are not equipotent.

 

Preferred list options

Class

Agent of Choice

Preferred List alternatives

Long acting beta agonists (LABAs)

Formoterol Easyhaler® 

Atimos Modulite®

(formoterol)

 

Long acting muscarinic antagonists (LAMAs)

Spiriva HandiHaler®

(tiotropium)

Eklira Genuair®

(aclidinium)

LABA / LAMA combination inhalers

Duaklir Genuair®

(aclidinium and formoterol)

 

Inhaled corticosteroids (ICS)

Clenil Modulite®

(beclometasone)

 

ICS / LABA combination inhalers

Fostair®

(beclometasone and formoterol)

Symbicort®

Duoresp Spiromax®

(budesonide and formoterol)

ICS / LABA combination inhalers (step 4 asthma guidelines only)

Flutiform 250/10®

(fluticasone and formoterol)

Seretide 500 Accuhaler®

(fluticasone and salmeterol)