COPD formulary treatment guide | Right Decisions

Please update your RDS mobile app to version 4.7.1

We are pleased to advise that deep linking capability, enabling users to directly download individual mobile toolkits, has now been released on the RDS mobile app. When you install the update, you will see that each toolkit has a small QR code icon the header area beside the search icon – see screenshot below. Clicking on this icon will open up a window with a full-size QR code and the alternative of a short URL for sharing with users. Instructions are provided.

You may need to actively install the update to install RDS app version 4.7.1 to see this improvement. Installing this update is also strongly recommended to get the full benefits of the new contingency arrangements – specifically, that if the RDS website should fail, you will still be able to download new mobile app toolkits.

To check your current RDS version, click on the three dots bottom right of the RDS app screen. This takes you to a “More” page where you will see the version number. To install latest updates:

On iPhones – go to the Apple store, click on your profile icon top right, scroll down to see the apps waiting to be updated and update the RDS app.

On Android phones – these can vary, but try going to the Google Play store, click on your profile icon top right, click on “Manage apps and device”, select and update the RDS app.

Please get in touch with ann.wales3@nhs.scot with any questions.

NHS Dumfries and Galloway Formulary choices for COPD treatment

Based on PCRS ‘Keep it Simple’ approach

All patients

Treat tobacco dependency
Offer flu vaccination
Optimise BMI
Promote exercise and pulmonary rehabilitation (if MRC≥3)

COPD with predominant breathlessness

SABA

Salbutamol Easyhaler (DPI) 200micrograms as needed (£3.31)
Salbutamol MDI 100micrograms as needed (£1.50)
Salamol Easibreathe (BA) 100micrograms as needed (£6.30)

Continued breathlessness that limits daily activities

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)

COPD with exacerbations (=/- breathlessness)

Continued breathlessness that limits daily activities

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)

Continued exacerbations

SABA + LAMA + (LABA + ICS)

Trimbow® 87/5/9 MDI or Nexthaler ®Two puffs twice daily (£44.50)
Trelegy® Ellipta® One puff daily (£44.50)

Review response after 3 months.

If no response, step down and refer to specialist

COPD with asthma

SABA + LABA/ICS

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), Bibefco 100/6 MDI (£13.98)
DuoResp Spiromax® (DP) 320/9 One puff bd (£29.97)
Relvar® Ellipta® (92mcg fluticasone furoate/22mcg vilanterol) One puff daily (£22.00)

Continued exacerbations or breathlessness

SABA + LAMA + (LABA + ICS)

Trimbow® MDI or Nexthaler ®Two puffs twice daily (£44.50)
Trelegy® Ellipta® One puff daily (£44.50)

Review response after 3 months.

If no response, step down and refer to specialist

Before changing medication, THINK AND DO*

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

If no response, consider referral to a specialist

(After referring to THINK AND DO points above *)

Last reviewed: 18/09/2024

Next review date: 18/09/2026

Author(s): Dr Emily Kennedy.

Version: 1