Related guidance:
Using inhaled or topical corticosteroids during breastfeeding (SPS July 2023)
For Steroid Emergency Card see NHS Somerset Formulary Corticosteriod responsive conditions.
| Therapeutic Area | Formulary Choices | Cost for 28 (unless otherwise stated) | Rationale for decision / comments |
|---|---|---|---|
| Beclometasone diproprionate | Prescribe by brand name. Clenil Modulite® and Qvar® are not equipotent nor are Soprobec® and Kelhale® 400mcg Soprobec® = 400mcg BDP 400mcg Clenil Modulite® = 400mcg BDP 200mcg Kelhale® = 400mcg BDP 200mcg Qvar® = 400-500mcg BDP 200mcg Fostair® = ~500mcg BDP 100mcg Trimbow® = 250mcg of BDP 400mcg budesonide (Pulmicort®/Symbicort®/Easyhaler®) = 400mcg BDP 200mcg fluticasone (Flixotide®/Seretide®/Flutiform®) = 400mcg BDP 160mcg ciclesonide = 240-320mcg BDP 200mcg mometasone furoate = 200mcg BDP |
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| Easyhaler® Dry powder inhaler  | 200mcg: £14.93 (200 dose) | For asthma: The usual starting dose is 200 micrograms twice a day. In more severe cases the starting dose may need to increase to 600 to 800 micrograms per day which may then be reduced when the patient's asthma has stabilised. The total daily dose may be administered as two, three, or four divided doses. |
|
| Soprobec® Metered dose inhaler  | 50mcg: £2.41 (200 dose) 100mcg: £4.82 (200 dose) 200mcg: £10.51 (200 dose) 250mcg: £10.59 (200 dose) | Children up to age 15 should use these products with a Volumatic® and patients 16 years and above should use a Volumatic if their dose is 1000mcg or more Both Soprobec and Clenil say suitable for children but do not specify an actual age. Consensus from professionals suggest 4 years and above. |
|
| Clenil® Metered dose inhaler | 50mcg: £3.70 (200 dose) 100mcg: £7.42 (200 dose) 200mcg: £16.17 (200 dose) 250mcg: £16.29 (200 dose) | ||
| as Kelhale® | 50mcg: £5.20 (200 dose) 100mcg: £5.20 (200 dose) | Kelhale is cost effective alternative to QVAR, and is considered equipotent. Benefit- has a dose counter Kelhale is licensed only for adults 18 years and above |
|
| as Qvar® | 50mcg: £7.87 (200 dose) 100mcg: £17.21 (200 dose) | Qvar® is not licensed in patients under 5yrs. |
|
| Breath-actuated CFC-free MDI as Qvar Easi-breathe® | 50mcg: £7.74 (200 dose) 100mcg: £16.95 (200 dose) | ||
| Budesonide | Dry Powder inhaler as Easyhaler® | 100mcg:£8.86 (200 dose) 200mcg £17.71 (200 dose) 400mcg: £17.71 (100 dose) | Licensed from age 6 years. In patients already controlled on inhaled corticosteroids (eg budesonide or beclometasone dipropionate) administered twice daily, once daily dosing up to 800 micrograms may be used. Adults with mild to moderate asthma (including the elderly and adolescents 12 to 17 years): In patients who have not previously received inhaled corticosteroids the usual maintenance dose is 200-400 micrograms once daily. In patients already controlled on inhaled corticosteroids (eg budesonide or beclometasone dipropionate) administered twice daily, once daily dosing up to 800 micrograms may be used. Children 6 to 11 years with mild to moderate asthma: In steroid naive patients or patients controlled on inhaled corticosteroids (eg budesonide or beclometasone dipropionate) administered twice daily the usual maintenance dose is 200-400 micrograms once daily. |
| Long-acting beta-agonist and corticosteroid | NICE TAG 138 states that for patients with chronic asthma in whom an ICS and LABA is appropriate, the following apply: - Use of a combination device within license is recommended as an option to ensure that long-acting β2 agonists are not taken without an inhaled steroid. - The decision to use combinations or separates should be made on an individual basis. - If a combination is chosen the least costly device that is suitable for the individual, within its license, is recommended |
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| Formoterol/budesonide | Fobumix Easyhaler® Dry powder inhaler | 4.5mcg/80mcg: £21.50 (120 dose) | For asthma: Adult: 1-2 inhalations twice daily. Some patients may require up to a maximum of 4 inhalations twice daily. |
| 4.5mcg/160mcg: £21.50 (120 dose) | For asthma: Adult: 1-2 inhalations twice daily. Some patients may require up to a maximum of 4 inhalations twice daily. For COPD: Adult: 2 inhalations twice daily. |
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| 9mcg/320mcg: £21.50 (60 dose) | For asthma: Adult: 1 inhalation twice daily. Some patients may require up to a maximum of 2 inhalations twice daily. For COPD: Adult: 1 inhalation twice daily. |
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| WockAIR® Dry powder inhaler | 4.5mcg/160mcg: £19.00 (120 dose) | For asthma: Adolescent: (12–17 years): 1-2 inhalations twice daily. Adult: 1-2 inhalations twice daily. Some patients may require up to a maximum of 4 inhalations twice daily. For COPD: Adult: 2 inhalations twice daily. |
|
| 9mcg/320mcg: £19.00 (60 dose) | For asthma. Adolescents (12-17 years): 1 inhalation twice daily. Adult: 1 inhalation twice daily. Some patients may require up to a maximum of 2 inhalations twice daily. For COPD. Adult: 1 inhalation twice daily. |
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| Duoresp Spiromax® Dry powder inhaler | 4.5mcg/160mcg: £27.97 (120 dose) | For asthma: Adolescent (12-17 years): 1-2 inhalations twice daily. Adult: 1-2 inhalations twice daily. Some patients may require up to a maximum of 4 inhalations twice daily. For COPD: Adult: 2 inhalations twice daily |
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| 9mcg/320mcg: £27.97 (60 dose) | For asthma: Adolescent: (12-17 years): 1 inhalation twice daily. Adults: 1 inhalation twice daily. Some patients may require up to a maximum of 2 inhalations twice daily. For COPD. Adult: 1 inhalation twice daily |
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| Symbicort Turbohaler® Dry powder inhaler | 6mcg/100mcg: £28.00 (120 dose) | For asthma. Children (6 years and older): 2 inhalations twice daily. Adolescents (12–17 years): 1-2 inhalations twice daily. Adults: 1-2 inhalations twice daily. Some patients may require up to a maximum of 4 inhalations twice daily. |
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| 6mcg/200mcg: £28.00 (120 dose) | For asthma. Adolescents (12-17 years): 1-2 inhalations twice daily. Adult: 1-2 inhalations twice daily. Some patients may require up to a maximum of 4 inhalations twice daily. For COPD. Adult: 2 inhalations twice daily. |
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| 12mcg/400mcg: £28.00 (60 dose) | For asthma: Adolescent: (12-17 years): 1 inhalation twice daily. Adult: 1 inhalation twice daily. Some patients may require up to a maximum of 2 inhalations twice daily. For COPD. Adult: 1 inhalation twice daily. |
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| Symbicort® Metered dose inhaler | 6mcg/200mcg: £28.00 (120 dose) | For COPD. Adult: 2 inhalation twice daily. |
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| Salmeterol/fluticasone | Campona Airmaster® Dry powder inhaler | 50mcg/100mcg: £7.95 (60 dose) | NHS Somerset classify salmeterol as not recommended. For asthma: Adult and adolescent 12 years and older: 1 inhalation twice daily. |
| 50mcg/250mcg: £8.95 (60 dose) | |||
| 50mcg/500mcg: £9.95 (60 dose) | For asthma: Adult and adolescent 12 years and older: 1 inhalation twice daily. For COPD: Adult: 1 inhalation twice daily. |
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| Fusacomb Easyhaler® Dry powder inhaler | 50mcg/250mcg: £21.50 (60 dose) | For asthma: Adult and adolescent 12 years and older: 1 inhalation twice daily. |
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| 50mcg/500mcg: £26.99 (60 dose) | For asthma: Adult and adolescent 12 years and older: 1 inhalation twice daily. For COPD: Adult: 1 inhalation twice daily. |
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| Fixkoh Airmaster® Dry powder inhaler | 50mcg/100mcg: £14.47 (60 dose) | For asthma: Adult and adolescent 12 years and older: 1 inhalation twice daily. |
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| 50mcg/250mcg: £19.29 (60 dose) | |||
| 50mcg/500mcg: £16.12 (60 dose) | For asthma: Adult and adolescent 12 years and older: 1 inhalation twice daily. For COPD: Adult: 1 inhalation twice daily. |
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| Seretide Accuhaler® Dry powder inhaler | 50mcg/100mcg: £17.46 (60 dose) | For asthma: Adult and adolescent 12 years and older: 1 inhalation twice daily. |
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| 50mcg/250mcg: £33.95 (60 dose) | |||
| 50mcg/500mcg: £32.74 (60 dose) | For asthma: Adult and adolescent 12 years and older: 1 inhalation twice daily. For COPD: Adult: 1 inhalation twice daily. |
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| Stalpex® Dry powder inhaler | 50mcg/500mcg: £16.12 (60 dose) | For asthma: Adult and adolescent 12 years and older: 1 inhalation twice daily. For COPD: Adult: 1 inhalation twice daily. |
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| AirFluSal Forspiro® Dry powder inhaler | 50mcg/500mcg: £29.97 (60 dose) | For asthma and COPD: Adult: 1 inhalation twice a day. |
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| Sereflo Ciphaler® Dry powder inhaler | 50mcg/250mcg: £10.99 (60 dose) | For asthma: Adults and adolescent 12 years of age and older: 1 inhalation twice a day. |
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| 50mcg/500mcg: £10.99 (60 dose) | |||
| Avenor® Metered dose inhaler | 25mcg/50mcg: £12.99 (120 dose) | For asthma: Adult and adolescent 12 years and older: 2 inhalations of 25mcg/125mcg twice daily. Children 4 years and older: 2 inhalations of 25mcg/50mcg twice daily. |
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| 25mcg/125mcg: £10.33 (120 dose) | |||
| 25mcg/250mcg: £13.66 (120 dose) | |||
| AirFluSal® Metered dose inhaler | 25mcg/125mcg: £16.42 (120 dose) | For asthma: Adult: 2 inhalations of 25mcg/125mcg twice daily. 25mcg/250mcg is non-formulary. |
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| Sereflo® Metered dose inhaler | 25mcg/125mcg: £14.99 (120 dose) |
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| Sirdupla® Metered dose inhaler | 25mcg/125mcg: £22.45 (120 doses) | ||
| Combisal® Metered dose inhaler | 25mcg/50mcg: £13.50 (120 dose) | For asthma: Adult: 2 inhalations of 25mcg/125mcg twice daily. Children 4 years and older: two inhalations of 25mcg/50mcg twice daily. 25mcg/250mcg is non-formulary. |
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| 25mcg/125mcg: £17.59 (120 dose) | |||
| Seretide Evohaler® Metered dose inhaler | 25mcg/50mcg: £17.46 (120 dose) | For asthma: Adult: 2 inhalations twice daily. Children 4 years and older: 2 inhalations of 25mcg/50mcg twice daily. 25mcg/250mcg is non-formulary. |
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| 25mcg/125mcg: £23.45 | |||
| Formoterol/fluticasone | Flutiform® Metered dose inhaler | 5mcg/50mcg: £14.40 (120 dose) | For asthma. Adult: 2 inhalations twice daily. Children aged 5 years and older: 2 inhalations of the 5mcg/50mcg twice daily. 10mcg/250mcg is non-formulary. |
| 5mcg/125mcg: £28.00 (120 dose) | |||
| Formoterol/beclometasone | Bibecfo® Metered dose inhaler | 6mcg/100mcg: £13.98 (120 dose) | For asthma and COPD: Adult: 1 or 2 inhalations twice a day. |
| 6mcg/200mcg: £13.98 (120 dose) | |||
| Luforbec® Metered dose inhaler | 6mcg/100mcg: £13.98 (120 dose) |
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| 6mcg/200mcg: £13.98 (120 dose) |
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| Fostair® Metered dose inhaler | 6mcg/100mcg: £29.32 (120 dose) | 6mcg/100mcg for asthma and COPD. 6mcg/200mcg for asthma only. Beclometasone-formoterol as maintenance and reliever therapy (MART): Patients over 18 years, at Step 3, who are poorly controlled may also use Fostair® as a rescue medication (maximum 8 puffs per day - equivalent 2000mcg standard BDP), with no Salbutamol. Careful patient education is required and quantity of inhalers used monitored. Beclomethasone 100mcg in Fostair® is equivalent to 250mcg of standard beclomethasone because of extra fine particle size. Patient should receive specific training and information leaflet on this issue. NEXThaler® has same BDP equivalent as Fostair MDI. |
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| 6mcg/200mcg: £29.32 (120 dose) |
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| Fostair NEXThaler® Dry powder inhaler | 6mcg/100mcg: £29.32 (120 dose) |
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| 6mcg/200mcg: £29.32 (120 dose) |
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| Indacaterol/mometasone | Atectura Breezhaler® Dry powder inhaler | 125mcg/127.5mcg: £21.50 (30 dose) | For maintenance treatment of asthma inadequately controlled by short-acting β2-agonists and inhaled corticosteroids. Adults and children over 12: One inhalation daily, titrated to the lowest effective mometasone dose. Max 125mcg/260mcg once daily. |
| 125mcg/260mcg: £27.97(30 dose) | |||
| Vilanterol/fluticasone | Relvar Ellipta® Dry powder inhaler | 22mcg/92mcg: £22.00 (30 dose) | For regular treatment of asthma where long acting β2-agonist and inhaled corticosteroid is appropriate. Adults and children over 12 years old: One inhalation daily, titrated to the lowest effective fluticasone dose. For symptomatic treatment of COPD with a post-bronchodilator FEV1 <70% predicted and a history of exacerbations despite regular bronchodilator therapy. Adult: One inhalation of 22mcg/92mcg daily. |
| 22mcg/184mcg: £29.50 (30 dose) |
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| Long-acting beta-agonist, corticosteroid and long-acting muscarinic antagonist | |||
| Vilanterol/fluticasone/umeclidinium | Trelegy Ellipta® Dry powder inhaler | 22mcg/92 mcg/55 mcg:£44.50 (30 dose) | Maintenance treatment of moderate to severe COPD who are not adequately treated by a combination of an inhaled corticosteroid and a long-acting β 2-agonist or a combination of a long-acting β 2-agonist and a long-acting muscarinic antagonist. Adult: 1 puff once daily. |
| Indacaterol/mometasone/glycopyrronium | Enerzair Breezhaler® Dry powder inhaler | 114mcg/136mcg/46mcg: £44.50 (30 dose) | Maintenance treatment of asthma inadequately controlled by a long-acting β2-agonist plus a high-dose inhaled corticosteroid, in patients with ≥1 severe exacerbations in the previous year. Adult: One puff daily. |
| Formoterol/beclometasone/glycopyrronium | Trimbow Nexthaler® Dry powder inhaler | 5mcg/88mcg/9mcg: £44.50 (120 dose) | Maintenance treatment in adult patients with moderate to severe COPD who are not adequately controlled by a combination of an inhaled corticosteroid and a LABA or a combination of LABA and LAMA. Adult: Two puffs twice daily. |
| Trimbow® Metered dose inhaler | 5mcg/87mcg/9mcg: £44.50 (120 dose) | COPD- Maintenance treatment in adult patients with moderate to severe COPD who are not adequately treated by a combination of an inhaled corticosteroid and a long acting beta2 agonist (LABA) or a combination of a LABA and long acting muscarinic antagonist (LAMA). Asthma-Maintenance treatment of asthma, in adults not adequately controlled with a maintenance combination of a long-acting beta2-agonist and medium dose of inhaled corticosteroid, and who experienced one or more asthma exacerbations in the previous year. Adult: Two puffs twice daily. |
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| 5mcg/172mcg/9mcg: £44.50 (120 dose) | Maintenance treatment of asthma, in adults not adequately controlled with a maintenance combination of a long-acting beta2-agonist and high dose of inhaled corticosteroid, and who experienced one or more asthma exacerbations in the previous year. Adult: Two puffs twice daily. |
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| Formoterol/budesonide/glycopyrronium | Trixeo Aerosphere® Metered dose inhaler | 5mcg/160mcg/9mcg: £44.50 (120 dose) | Maintenance treatment in adult patients with moderate to severe COPD who are not adequately treated by a combination of an inhaled corticosteroid and a long-acting beta2-agonist or combination of a long-acting beta2-agonistand a long-acting muscarinic antagonist. Adult: Two puffs twice daily. |
| Spacer devices | Patient's ability to use different devices varies; assessment of response to a prescribed treatment should include evaluation of inhaler technique as demonstrated by patient. MHRA states- spacers should not be considered as interchangeable: patients who use a spacer with their inhaler should use a spacer named in the summary of product characteristics SPC (where specified by name) | ||
| Small volume: | A2A® with small or medium mask | £4.15 (1) £6.68 (1) | The A2A™ is a collapsable version of the Able™, pocket-sized when collapsed for increased portability and discreetness. Made in the UK, to help support NHS carbon net zero plans. |
| Able® with either small (infant) or medium (child) mask | £4.39 (1) £7.16 (1) | Made in the UK, to help support NHS carbon net zero plans. | |
| Medium volume: | EasyChamber® adult with mouthpiece (blue) with infant mask (orange) with child mask (yellow) with adult mask (blue) AeroChamber Plus® standard adult (blue) adult with mask (blue) infant with mask (orange) child with mask (yellow) AeroChamber Plus Flow-Vu Anti-Static® Standard Youth (5+ years) Small mask for infants (0-18 months) Medium mask for children (1-5 years) Adult small mask Adult large mask | £3.98 (1) £6.53 (1) £6.55 (1) £6.59 (1) £5.21(1) £8.69 (1) £8.69 (1) £8.69 (1) £5.22 £5.22 £8.72 £8.72 £8.72 £8.72 | Easychamber® is the most cost effective spacer. Anti-static with universal inhaler base that fits majority of pMDIs. Detachable, latex-free mask. Comes with outer box for easy storage. One-way inhalation cross valve. FlowSignal whistle indicator sounds when breathing in too fast. AeroChamber Plus® spacer devices should fit ALL MDI devices (inhaler mouthpiece fits into flexible gasket) |
| Large volume: | Volumatic® | £3.88 (1) | Volumatic® spacer device is only compatible with inhalers manufactured by GSK or if mouthpiece has same specifications as inhalers manufactured by GSK. Patients 16 years and above must use a Volumatic spacer device if their total daily dose exceeds 1000mcg beclometasone diproprionate equivalent |