Warning

*Consider carbon footprint of inhalers: MDI higher than DPI, Optimise therapy and check inhaler technique*

Step 1 - Regular low dose inhaled steroid

Formulary Choices:
Soprobec 100mcg 2 puffs BD (£3.34)
Kelhale 50 2 puffs BD (£3.12)
Qvar 50 Easi-Breathe 2 puffs BD(£4.64)

Equivalents - Non Formulary:
Clenil 100mcg 2 Puffs BD (£4.45) equivalent to Soprobec
Qvar 50mcg 2 puffs BD MDI (£4.72) equivalent to Kelhale

Step 2 – Add regular long acting beta agonist (LABA) – Fixed dose or MART

Formulary Choices:
Swap to Luforbec (100/6) 1 puff BD (£10.26); Bibefco 100/6 1 puff BD (£10.26) does not contain maleic acid as excipient

Equivalents - Non Formulary:
Add Serevent Evohaler 2 puffs BD (£29.26); Fostair 100/6 1 puff BD (£14.66); Flutiform 50/5 2 puffs BD (£18.00); Seretide Evohaler 50 2 puffs BD (£17.46); Combisal (£13.50)

Note Kelhale, Qvar, Luforbec, Fostair, Flixotide, Flutiform, Seretide and Asmanex are ‘double strength’ compared to standard Beclometasone. Costs for 30 days

Step 3 – Increase to medium dose inhaled steroid

Formulary Choices:
Luforbec 100/6 2 puffs BD (£20.52)

Equivalents - Non Formulary:
Beclometasone 400mcg BD plus LABA Fostair 100/6 2 puffs BD (£29.32); Flutiform 125/5 2 puffs BD (£28.00); Seretide Evohaler 125 2 puffs BD (£23.45) also available as: Aloflute (£22.45), Combisal (£17.59), Sereflo (£14.99), Sirdupla (£22.45)

Step 4 – Review diagnosis - referral/discussion with specialist before increase to high dose inhaled steroid

Formulary Choices:
Fostair 200/6 2 puffs BD (£29.32); Luforbec 200/6 2 puffs BD (£13.98); Bibefco 200/6 2 puffs BD (£13.98) does not contain maleic acid as excipient

Equivalents - Non Formulary:
Beclometasone 800mcg BD plus LABA Flutiform 250/5 2 puffs BD (£45.56); Seretide Evohaler 250 2 puffs BD (£29.32) also available as: AirFluSal (£20.52), Aloflute (£28.32), Combisal (£27.99), Sereflo (£19.99) , Sirdupla (£28.32)

Reliever as required – Consider step up if using 3 doses a week or more

Formulary choice:
Salbutamol MDI 2 puffs as required(£1.50); Salamol Easi-Breathe MDI (£6.30)

Editorial Information

Last reviewed: 28/11/2024

Next review date: 29/11/2026

Author(s): Emily Kennedy.

Version: 1