Long-acting antimuscarinic bronchodilators (LAMA) in COPD (Formulary)

Consider umeclidinium as first choice for patients with moderate or severe COPD (FEV1 60% or less and frequent exacerbations and breathlessness). Stop ipratropium if a long-acting antimuscarinic bronchodilator is started. Assess after 2 months and discontinue if no improvement. Advise patients that dry mouth is a frequent side-effect.

UMECLIDINIUM - (First line)

Important: Therapy notes

Important: Formulation and dosage details

Formulation:

PREFERRED: Dry Powder Inhaler (DPI) (Inhalation powder)These are more environmentally friendly than MDIs and should be considered first line providing that the patient shows good inhaler technique with the chosen device. 

  • Dry Powder inhaler (Incruse Ellipta®) 55 micrograms/inhalation

Dosage:

COPD, by inhalation of powder: 1 inhalation once daily.

TIOTROPIUM

Important: Therapy notes

Important: Formulation and dosage details

Formulation:

PREFERRED: Dry Powder Inhaler (DPI) (Inhalation powder)These are more environmentally friendly than MDIs and should be considered first line providing that the patient shows good inhaler technique with the chosen device. 

  • Inhalation powder capsules (Spiriva®) (for use with HandiHaler® device) 18 micrograms, capsule pack with HandiHaler® device, capsule refill

Dosage:

COPD, by inhalation of powder: 18 micrograms (1 capsule) once daily. 

Important: Formulation and dosage details

Formulation:

PREFERRED: Soft Mist Inhaler (SMI) These are more environmentally friendly than MDIs and should be considered first line providing that the patient shows good inhaler technique with the chosen device. 

  • Solution for inhalation cartridge (Spiriva® Respimat®) 2·5 micrograms/metered inhalation

Dosage:

COPD, by inhalation of aerosol (Spiriva® Respimat®), 5 micrograms (2 puffs) once daily. 

As per SMC 411/07: as a maintenance bronchodilator treatment to relieve symptoms of patients with chronic obstructive pulmonary disease (COPD). 

ACLIDINIUM

Important: Therapy notes

Important: Formulation and dosage details

Formulation:

PREFERRED: Dry Powder Inhaler (DPI) (Inhalation powder)These are more environmentally friendly than MDIs and should be considered first line providing that the patient shows good inhaler technique with the chosen device. 

  • Dry powder inhaler (Eklira Genuair®) 322 micrograms/inhalation

Dosage:

COPD, by inhalation of powder: 1 inhalation twice daily.  

Editorial Information

Document Id: F349