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1st 1st
choice choice
2nd 2nd
choice choice
or 3rd
choice
or or
• DuoResp® Spiromax 160/4.5 & 320/9 = budesonide and formoterol; dry powder inhaler (DPI); equivalent to
Symbicort 200/6 & 400/12 respectively but more cost effective. Licensed in asthma & COPD (18 years and over);
200/6 strength licensed for asthma maintenance and reliever treatment (MART)
• Flutiform® MDI = fluticasone propionate and formoterol; 50/5 and 125/5 strength licensed in asthma (12 years and
over); 250/5 strength licensed in asthma (18 years and over)
• Fostair® 100/6 & 200/6 = extra-fine particle size beclometasone and formoterol: 100micrograms extra-fine particle
size beclometasone is equivalent to approximately 250micrograms BDP:
o Fostair® 100/6 metered dose inhaler (MDI) & NEXThaler® (DPI): licensed in asthma (18 years and over) and
COPD; only Fostair 100/6 MDI is licensed for asthma MART
o Fostair® 200/6 MDI and NEXThaler® (DPI): licensed in asthma (18 years and over)
• Relvar® Ellipta = fluticasone furoate* and vilanterol; DPI; 92/22 strength licensed in asthma & COPD (12 years
and over); 184/22 strength licensed in asthma only (12 years and over)
*Prescribers should be aware that the fluticasone furoate contained in Relvar® preparations is not equivalent to
fluticasone propionate. In patients with asthma, fluticasone furoate 100 micrograms once daily is approximately
equivalent to fluticasone propionate 250 micrograms twice daily. For other prescribing/ licensing information
please see individual SPC for guidance: https://www.medicines.org.uk/emc/
• Seretide® Evohaler (MDI) & Accuhaler (DPI): fluticasone propionate and salmeterol; Evohaler® 50 & Accuhaler®
100 licensed for asthma (5 years and over); Evohaler® 125 & 250 & Accuhaler® 250 licensed for asthma (12 years
and over); Accuhaler® 500 licensed for asthma & COPD (12 years and over)
• Symbicort® 200/6 & 400/12 Turbohaler= budesonide and formoterol; DPI; licensed for asthma & COPD (12 years
and over); 200/6 strength licensed for Symbicort maintenance and reliever therapy (SMART)
Step 3
1st choice
2nd choice
or
Other ICS/LABA inhalers available at Step 3 for the management of COPD but are not included in the
NHSGG&C formulary preferred list:
1. Relvar® Ellipta 92/22 , one puff once daily = fluticasone furoate* and vilanterol
2. Seretide® 500 Accuhaler, one puff twice daily = fluticasone propionate and salmeterol
To prevent confusion, all inhalers should be prescribed by brand name, with the exception of salbutamol MDI’s
= black triangle medicine, subject to additional monitoring by the European Medicines Agency