MTW NHS Trust West Kent CCG

Drug Status Key

  • Preferred
  • Second Line
  • Third Line
  • Specialist Initiation
  • Hospital Only
  • Not Approved for Formulary

Corticosteroids (inhaled)

Drug Safety Update

  October 2007: Inhaled corticosteroids and pneumonia

  July 2008: Inhaled medicines containing corticosteroids various safety issues

  December 2014 : Inhaled and intranasal corticosteroids risk of psychological and behavioural side effects

  August 2017: Corticosteroids rare risk of central serious chorioretinopathy with local as well as systemic administration 

 July 2018: Pressurised metered dose inhalers (pMDI): risk of airway  obstruction from aspiration of loose objects

National Guidance

  NG115: Chronic obstructive pulmonary disease in over 16s - diagnosis and management, December 2018

  NG80: Asthma diagnosis, monitoring and chronic asthma management November 2017

 BTS/SIGN British Guideline on the management of asthma September 2016

  TA138: Corticosteroids for the treatment of chronic asthma in adults and children aged 12 years and over March 2008

Beclometasone is the first choice because it is as effective but less expensive than alternative steroid inhalers at standard equivalent doses.

Beclometasone, budesonide and fluticasone appear to be equally effective although fluticasone is twice as potent as the other two agents. 

Beclometasone metered dose inhalers should be prescribed by brand name due to differences in potency. Qvar is formulated with extra fine particles of beclometasone and is more potent than other brands.

Spacer: at doses greater than beclometasone 800micrograms daily or equivalent a spacer device should be used. 

Steroid card: higher doses of inhaled corticosteroids do have the potential to induce adrenal suppression. Patients receiving >1500 micrograms beclometasone inhaled daily or equivalent may have systemic side effects and should be given a steroid card.

COMBINATION INHALED STEROIDS AND LONG-ACTING BETA-2 AGONISTS

Fostair is formulated with extra-fine particles of beclometasone and is more potent than other formulations. The beclometasone dose in Fostair is equivalent to Qvar.

Accuhaler devices are formulated for doses of one puff inhaled twice daily

Symbicort 100/6 and 200/6 turbohalers can be used for both asthma maintenance therapy and the relief of acute symptoms. Symbicort pMDI is only licensed for COPD.

Relvar Ellipta contains a more potent fluticasone salt - fluticasone furoate 92 micrograms once daily is equivalent to fluticasone propionate 250 micrograms twice daily.

TRIPLE INHALER THERAPY

Triple inhaler therapy (LABA/LAMA/ICS) is indicated in COPD patients who are in GOLD guidelines D. i.e. patients who are having more than two exacerbations a year, more symptomatic despite on dual bronchodilators with raised eosinophil counts or patients with Asthma COPD overlap syndrome.

Clenil Modulite and Qvar are not interchangeable and should be prescribed by brand name

Pack Price
200 dose £3.70
Pack Price
200 dose £7.42
Pack Price
200 dose £16.17
Pack Price
200 dose £16.29

Qvar is not dose equivalent to other beclometasone containing inhalers

Pack Price
200 dose £7.87

Qvar is not dose equivalent to other beclometasone containing inhalers

Pack Price
200 dose £17.21

Qvar is not dose equivalent to other beclometasone containing inhalers

Pack Price
200 dose £7.87

Qvar is not dose equivalent to other beclometasone containing inhalers

Pack Price
200 dose £7.74

Qvar is not dose equivalent to other beclometasone containing inhalers

Pack Price
200 dose £16.95

Contains beclometasone dipropionate and formoterol fumarate dihydrate

Fostair is formulated with extra-fine particles of beclometasone and is more potent than some other formulations. The beclometasone dose in Fostair is equivalent to Qvar.

Pack Price
120 dose £29.32
Pack Price
120 dose £29.32

Fostair NEXThaler

Pack Price
120 dose £29.32

Fostair NEXThaler

Pack Price
120 dose £29.32

Contains budesonide and formoterol fumarate dihydrate

Symbicort Turbohaler

Pack Price
120 dose £28.00

Symbicort Turbohaler

Pack Price
120 dose £28.00
60 dose
Pack Price
120 dose £28.00

Symbicort Turbohaler

Pack Price
60 dose £28.00

Each delivered dose (the dose that leaves the mouthpiece of the Spiromax) contains 160 micrograms of budesonide and 4.5 micrograms of formoterol fumarate dihydrate.

This is equivalent to a metered dose of 200 micrograms budesonide and 6 micrograms of formoterol fumarate dihydrate.

Pack Price
120 dose £27.97

Each delivered dose (the dose that leaves the mouthpiece of the Spiromax) contains 320 micrograms of budesonide and 9 micrograms of formoterol fumarate dihydrate.

This is equivalent to a metered dose of 400 micrograms budesonide and 12 micrograms of formoterol fumarate dihydrate.

Pack Price
60 dose £27.97

Relvar Ellipta contains fluticasone furoate which is more potent than fluticasone propionate see notes above

Pack Price
30 dose £22.00
Pack Price
30 dose £29.50