Corticosteroids

NHSL Medicines Guidance
NHS Lanarkshire

Inhaled Corticosteroids (ICS) for Asthma

Information for Prescribers: Update to Adult Asthma Guidelines (May 2025)

NHS Lanarkshire has updated its guidance on the Pharmacological Management of Adult Asthma in Primary & Secondary Care. The revised guideline recommends two treatment pathways for newly diagnosed or symptomatic asthma patients:

  • Anti-Inflammatory Reliever (AIR)
  • Maintenance and Reliever Therapy (MART)

Both pathways use combination inhalers containing an inhaled corticosteroid (ICS) and formoterol, and do not include single-agent ICS inhalers.

Patients who are stable, asymptomatic, and satisfied with their current traditional treatment should not be switched to these new pathways unless there is another reason to change therapy.  Updated formulary choices for single-agent ICS inhalers for use in the traditional treatment pathway are listed below, and replace the previous formulary options of Clenil Modulite® and Qvar®.

Preferred list (P)

Lanarkshire Preferred formulary options within the traditional adult asthma treatment pathway for regular low dose ICS (for use with as needed SABA reliever inhaler).

BECLOMETASONE (Soprobec®)

BUDESONIDE (Easyhaler®)

Brand Inhaler type Carbon Footprint* 
Soprobec® pMDI High
Easyhaler Budesonide® DPI Low

*Low (<35 g CO2e) or High (≥35 g CO2e) carbon footprint per puff

Reference:PrescQIPP Bulletin 295 [Accessed 03.09.2025]

Prescribing Notes:

  • The MHRA has advised (Aug 2006) that CFC-free beclometasone dipropionate inhalers are not equipotent or interchangeable.
  • Inhalers should be prescribed by brand name.

Combination Preparations for Asthma: Low or Medium Dose ICS With LABA

Information for Prescribers: Update to Adult Asthma Guidelines (May 2025)

NHS Lanarkshire has updated its guidance on the Pharmacological Management of Adult Asthma in Primary & Secondary Care. The revised guideline recommends two treatment pathways for newly diagnosed or symptomatic asthma patients:

  • Anti-Inflammatory Reliever (AIR)
  • Maintenance and Reliever Therapy (MART)

Both pathways use combination inhalers containing an inhaled corticosteroid (ICS) and formoterol.

Patients who are stable, asymptomatic, and satisfied with their current traditional treatment should not be switched to these new pathways unless there is another reason to change therapy.  Formulary choices for the traditional treatment pathway are listed below.

Preferred list (P)

BUDESONIDE WITH FORMOTEROL (Symbicort® 200micrograms/6micrograms)

  • Preferred formulary option for AIR pathway and low or moderate dose MART pathway (as per license).
  • Non-formulary within the traditional adult asthma treatment pathway.

BECLOMETASONE WITH FORMOTEROL (Luforbec® 100micrograms/6micrograms)

  • Preferred formulary option for low or moderate dose MART pathway and within the traditional adult asthma treatment pathway for low/moderate dose ICS/LABA (for use with as needed SABA reliever inhaler).
  • Luforbec® is twice as potent as Soprobec®, therefore 100mcg beclometasone in Luforbec® is equivalent to 200mcg in Soprobec®.
Brand Inhaler type Carbon footprint*
Symbicort Turbohaler® DPI  Low
Luforbec® pMDI  High

*Low (<35 g CO2e) or High (≥35 g CO2e) carbon footprint per puff

Reference: PrescQIPP Bulletin 295 [Accessed 03.09.2025]

 

Total list (T)

BUDESONIDE WITH FORMOTEROL (Fobumix Easyhaler® 160micrograms/dose / 4.5micrograms/dose)

  • Total formulary option for low or moderate dose MART pathway.
  • Preferred formulary option within the traditional adult asthma treatment pathway regular low/moderate dose ICS/LABA (for use with as needed SABA reliever inhaler).

FLUTICASONE WITH VILANTEROL (Relvar Ellipta® 92micrograms/22micrograms)

  • Total formulary option within the traditional adult asthma treatment pathway for regular low/moderate dose ICS/LABA (for use with as needed SABA reliever inhaler).
Brand Inhaler type Carbon footprint*
Fobumix Easyhaler® DPI Low
Relvar Ellipta® DPI Low 

*Low (<35 g CO2e) or High (≥35 g CO2e) carbon footprint per puff

Reference: PrescQIPP Bulletin 295 [Accessed 03.09.2025]

Prescribing Notes:

  • Only specific brands of ICS/formoterol inhalers are licensed for MART. 
  • Inhalers should be prescribed by brand name.

Combination Preparations for Asthma: High Dose ICS With LABA

Specialist initiation (S1)

FLUTICASONE WITH VILANTEROL (Relvar Ellipta® 184micrograms/22micrograms)

  • Specialist initiation (S1) formulary option within the traditional adult asthma treatment pathway for regular high dose ICS/LABA (for use with as needed SABA reliever inhaler).
Brand Inhaler type Carbon footprint*
Relvar Ellipta® DPI Low

*Low (<35 g CO2e) or High (≥35 g CO2e) carbon footprint per puff

Reference: PrescQIPP Bulletin 295 [Accessed 03.09.2025]

Prescribing Notes:

  • NHS Lanarkshire has updated its guidance on the Pharmacological Management of Adult Asthma in Primary & Secondary Care(May 2025). As such, DuoResp Spiromax® 320micrograms/9micrograms, Symbicort® 400micrograms/12micrograms, Luforbec® 200micrograms/6micrograms pMDI and Fostair® NEXThaler® 200/6 DPI are no longer formulary options for the management of Asthma in NHS Lanarkshire. Patients who are stable, asymptomatic, and satisfied with their current traditional treatment should not be switched to these new pathways unless there is another reason to change therapy. 
  • Inhalers should be prescribed by brand name.

Combination Preparations for Asthma: High Dose ICS With LABA and LAMA (Triple Therapy)

Specialist initiation (S1)

BECLOMETASONE WITH FORMOTEROL AND GLYCOPYRRONIUM (Trimbow® 172micrograms/ 5 micrograms/ 9 micrograms)

  • Specialist initiation (S1) formulary option within the traditional adult asthma treatment pathway for high dose ICS/LABA and LAMA with SABA reliever as an alternative to high dose ICS/LABA and a LAMA in separate devices.
  • SMC Advice SMC2334 Trimbow®
  • Please note Trimbow® 172micrograms/ 5 micrograms/ 9 micrograms pMDI is not licensed for use in COPD.
Brand Inhaler type Carbon footprint*
Trimbow® pMDI  High 

*Low (<35 g CO2e) or High (≥35 g CO2e) carbon footprint per puff

Reference: PrescQIPP Bulletin 295 [Accessed 03.09.2025]

Prescribing Notes:

  • Inhalers should be prescribed by brand name.

Combination Preparations for COPD: ICS With LABA and LAMA (Triple Therapy)

Preferred list (P)

FLUTICASONE WITH UMECLIDINIUM AND VILANTEROL (Trelegy Ellipta®)

FORMOTEROL WITH GLYCOPYRRONIUM AND BUDESONIDE (Trixeo Aerosphere®)

Brand Inhaler type Carbon footprint*
Trelegy Ellipta® DPI Low
Trixeo Aerosphere® pMDI High

*Low (<35 g CO2e) or High (≥35 g CO2e) carbon footprint per puff

Reference: PrescQIPP Bulletin 295 [Accessed 03.09.2025]

 

Total list (T)

BECLOMETASONE WITH FORMOTEROL AND GLYCOPYRRONIUM (Trimbow®)

Brand Inhaler type

Carbon footprint*
Trimbow NEXThaler® DPI Low
Trimbow® pMDI High

*Low (<35 g CO2e) or High (≥35 g CO2e) carbon footprint per puff

Reference: PrescQIPP Bulletin 295 [Accessed 03.09.2025]

Prescribing Notes:

  • As per SMC advice for adult patients with severe COPD (forced expiratory volume in one second [FEV1] <50% predicted normal) who are not adequately treated by a combination of an inhaled corticosteroid and a long-acting β2-agonist.
  • Inhalers should be prescribed by brand name.
  • For further advice on the treatment of COPD and dosing regimens please see the NHSL Guideline for the Pharmacological Management of COPD.

Systemic Corticosteroids

Preferred list (P)

PREDNISOLONE (oral)

  • Use standard 5mg prednisolone tablets rather than soluble or enteric coated tablets.
  • 25mg tablets are non-formulary.

HYDROCORTISONE (Intravenous)

  • Hospital preferred list

NHSL Joint Adult Formulary Key

To indicate the category of a formulary medicine, updated sections adopt the following key:

Preferred list (P): First-line formulary choices.

 

Total list (T): Alternative choices when preferred list options not effective/not tolerated, or not indicated.

 

Specialist initiation (S1): Specialist initiation, or on the advice of a Consultant or Specialist Practitioner in this therapeutic area. Continuation in primary care is acceptable.

 

Specialist use only (S2): Supply via hospital, Homecare Service or a hospital based prescription (HBP) for dispensing by community pharmacy. Not prescribed in primary care setting.

Editorial Information

Last reviewed: 22/10/2025

Author(s): NHSL.

Version: Please refer to the introduction section for an explanation of the review dates above.

Approved By: ADTC

Reviewer name(s): ADTC.