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

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

  NG80: Asthma diagnosis, monitoring and chronic asthma management, November 2017 (updated March 2021)

  NG115: Chronic obstructive pulmonary disease in over 16s - diagnosis and management, December 2018 (updated July 2019)

  BTS/SIGN British Guideline on the management of asthma, July 2019

Local Guidance

Please refer to the Primary Care Management of COPD guidance

  • The NHS aims to be the world's first net carbon zero health service and metered dose inhalers are a major contributing factor to the carbon footprint of the NHS. Where clinically appropriate, consider a dry powder inhaler for newly diagnosed patients. 
  • Following a thorough annual review of existing patients, consider switching from a MDI to a DPI with appropriate inhaler techniques counselling and inspiratory flow assessment. The majority of salbutamol inhalers are prescribed as MDIs, and a switch from Ventolin to Salamol or Airomir would lower the carbon footprint. This can also be achieved by reducing the number of salbutamol inhalers prescribed following thorough review. See Prescqipp for further information regarding the carbon footprint of inhalers. 
  • Generic prescribing of inhalers should be avoided as this might lead to patients being given an unfamiliar inhaler device, which they are not able to use properly. Different products and doses are licensed for different age groups and some may be applicable only to older children or adults (aged 18 years and over). Prior to prescribing, the relevant Summary of Product Characteristics (SPC) should be checked.
  • Some inhalers contain extra-fine particles (Qvar), making them more potent than others (Clenil). Take care to prescribe by brand.
  • Issue a steroid treatment card to people who are using prolonged high doses (more than 1000 micrograms beclomethasone per day,  or equivalent) of inhaled corticosteroids (ICS). Also consider the use of a spacer with medium-high dose inhaled ICS (via a metered dose inhaler) for those patients at risk of developing oral candidiasis.

TRIPLE INHALER THERAPY

  • Trimbow is now licensed for the treatment of asthma, but this should be specialist initiation only. Trimbow remains available for primary care initiation for the treatment of COPD.
  • Trimbow NEXThaler is only licensed for the treatment of COPD.
  • Enerzair Breezhaler is only licensed for the treatment of asthma.

 

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

Trimbow is now licensed for the treatment of asthma, but this should be specialist initiation only.

Trimbow remains available for primary care initiation for the treatment of COPD.

Trimbow NEXThaler is licensed for the treatment of COPD.

Pack Price
120 dose £44.50
Pack Price
120 dose

Licensed for the treatment of asthma only

Pack Price
30 capsule (3 x 10 capsules + 1 sensor) £44.50
30 capsule (3 x 10 capsules) £44.50