- Treat tobacco dependency
- Offer flu vaccination
- Optimise BMI
- Promote exercise and pulmonary rehabilitation (if MRC≥3)
COPD formulary treatment guide
NHS Dumfries and Galloway Formulary choices for COPD treatment
Based on PCRS ‘Keep it Simple’ approach
SABA
- Salbutamol MDI 100micrograms as needed (£1.50)
- Salbutamol Easyhaler (DPI) 200micrograms as needed (£3.31)
- Salamol Easibreathe (BA) 100micrograms as needed (£6.30)
Using SABA daily
SABA + LAMA (or LABA)
- Spiriva® (tiotropium) Respimat® 2.5micrograms, Two puffs daily (£23.00)
- Acopair® inhalation capsules 10mcg with Neumohaler ® (tiotropium). Inhale contents of one capsule daily (£19.99)
- Incruse® (umeclidinium) Ellipta® 55micrograms once daily (£27.50)
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)
- Spiriva® (tiotropium) Respimat® 2.5micrograms,Two puffs daily (£23.00)
- Acopair® inhalation capsules 10mcg with Neumohaler® (tiotropium). Inhale contents of one capsule daily (£19.99)
- Incruse® (umeclidinium) Ellipta® 55micrograms once daily (£27.50)
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)
SABA + LAMA + (LABA + ICS)
- Trimbow® MDI or Nexthaler ®Two puffs twice daily (£44.50)
- Trelegy® Ellipta® One puff daily (£44.50)
If no response, step down and refer to specialist
- 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)
- DuoResp Spiromax® (DP) 320/9 One puff bd (£29.97)
- Relvar® Ellipta® (92mcg fluticasone furoate/22mcg vilanterol) One puff daily (£22.00)
SABA + LAMA + (LABA + ICS)
- Trimbow® MDI or Nexthaler ®Two puffs twice daily (£44.50)
- Trelegy® Ellipta® One puff daily (£44.50)
If no response, step down and refer to specialist
- 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
(After referring to THINK AND DO points above *)