COPD formulary treatment guide

DGRefHelp - NHS Dumfries & Galloway
NHS Dumfries and Galloway

NHS Dumfries and Galloway Formulary choices for COPD treatment

Based on PCRS ‘Keep it Simple’ approach

All patients

  • Treat tobacco dependency
  • Offer flu vaccination
  • Optimise BMI
  • Promote exercise and pulmonary rehabilitation (if MRC≥3)

COPD with predominant breathlessness

SABA

  • Salbutamol Easyhaler (DPI) 200micrograms as needed (£3.31)
  • Salbutamol MDI 100micrograms as needed (£1.50)
  • Salamol Easibreathe (BA) 100micrograms as needed (£6.30)                                

Continued breathlessness that limits daily activities

SABA + (LAMA/LABA)

  • Spiolto® (tiotropium/olodaterol) Respimat® 2.5/2.5micrograms, Two puffs daily (£32.50)
  • Anoro® Ellipta® (umeclidinium 65mcg/vilanterol 22mcg) One puff daily (£32.50)

COPD with exacerbations (=/- breathlessness)

Continued breathlessness that limits daily activities

SABA + LAMA/LABA

  • Spiolto (tiotropium/olodaterol) Respimat 2.5/2.5micrograms, Two puffs daily (£32.50)
  • Anoro® Ellipta® (umeclidinium 65mcg/vilanterol 22mcg) One puff daily (£32.50)
Continued exacerbations

Consider triple inhaled therapy if:

  • 2 or more exacerbations in previous year or admission AND
  • Eosinophil count ≥ 0.3 x109/l

SABA + LAMA + (LABA + ICS)

  • Trimbow® 87/5/9 MDI or Nexthaler ®Two puffs twice daily (£44.50)
  • Trelegy® Ellipta® One puff daily (£44.50)
Review response after 3 months.

If no response, step down.

COPD with asthma

SABA + LABA/ICS
  • Fobumix Easyhaler® (DP) 320/9 One puff bd (£21.50)or 160/4.5 Two puffs bd (£21.50)
  • Fostair® 100/6 Nexthaler® Two puffs bd (£29.32) Or Luforbec® 100/6 MDI (£20.52), Bibefco 100/6 MDI (£13.98)
  • DuoResp Spiromax® (DP) 320/9 One puff bd (£29.97)
  • Relvar® Ellipta® (92mcg fluticasone furoate/22mcg vilanterol) One puff daily (£22.00)
Continued exacerbations or breathlessness

SABA + LAMA + (LABA + ICS)

  • Trimbow® 87/5/9 MDI or Nexthaler ®Two puffs twice daily (£44.50)
  • Trelegy® Ellipta® One puff daily (£44.50)
Review response after 3 months.

If no response, step down 

Before changing medication, THINK AND DO*

  • Check inhaler technique
  • Check Compliance
  • Recheck diagnosis
  • Smoking status?
  • Co-morbidities?

 

Think about carbon footprint of inhaler choices

Low carbon footprint <35g CO2e per puff Vs High carbon footprint >35gCO2e per puff

If no response, consider referral to a specialist

(After referring to THINK AND DO points above *)

Editorial Information

Last reviewed: 18/09/2024

Next review date: 18/09/2026

Author(s): Dr Emily Kennedy.

Version: 1