Related guidance:

Inhaled corticosteroids for the treatment of chronic asthma in adults and in children aged 12 years and over Technology appraisal guidance (TA138 March 2008)

Using inhaled or topical corticosteroids during breastfeeding (SPS July 2023)

For Steroid Emergency Card see NHS Somerset Formulary Corticosteriod responsive conditions.

Therapeutic AreaFormulary ChoicesCost for 28
(unless otherwise stated)
Rationale for decision / comments
Inhaled
corticosteroids (ICS)
The BTS / SIGN Guideline on the management of asthma states: many children with recurrent episodes of viral-induced wheezing in infancy do not develop chronic atopic asthma and do not require regular inhaled steroids.
NICE TAG138 states: for patients with chronic asthma in whom an ICS is appropriate, the least costly product that is suitable for the individual, within its license, is recommended
BeclometasoneNB. Prescribe beclometasone MDIs by brand name to avoid confusion over the product intended. 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
400mcg budesonide (Pulmicort®/Symbicort®/Easyhaler®) = 400mcg BDP
200mcg fluticasone (Flixotide®/Seretide®/Flutiform®) = 400mcg BDP
160mcg ciclesonide = 240-320mcg BDP
200mcg mometasone furoate = 200mcg BDP
BTS guide to ICS potencies pages 67-69
Choose a dry powder inhaler wherever possible
Beclometasone diproprionate
In no particular order#
Dry powder
as Beclometasone Easyhaler®
Green Footprint
200mcg: £14.93 (200 dose) Not suitable for children, though SPC does not specify age range this covers. Budesonide Easyhaler can be used from 6 years and has a once daily license if required. See below
pMDIsCFC-free MDIs
as Soprobec®
Red Footprint



as Clenil Modulite®
Red Footprint
50 mcg:£2.78(200 dose)
100 mcg=£5.57 (200 dose)
200 mcg=£12.13 (200 dose)
250 mcg=£12.22 (200 dose)

50mcg: £3.70 (200 dose)
100mcg: £7.42 (200 dose)
200mcg: £16.17 (200 dose)
250mcg: £16.29 (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.
as Kelhale®
Red Footprint
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®
Red Footprint
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®
Red Footprint
50mcg: £7.74 (200 dose)
100mcg: £16.95 (200 dose)
Budesonide Dry Powder inhaler
as Easyhaler®
Green Footprint
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.
Combination
long-acting
beta-agonist steroid
inhalers
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
Budesonide/formoterolFobumix Easyhaler®
Budesonide/formoterol
dry
powder inhaler

Green Footprint
80mcg/4.5mcg: £21.50 (120 doses)
160mcg/4.5mcg: £21.50 (120 doses)
320mcg/9mcg; £21.50 (60 doses)
Not under 18 years, suggest WockAIR (12 years+)
WockAIR
Budesonide/formoterol
Dry powder inhaler
Green Footprint
160mcg/4.5mcg £19.00 120 doses
320mcg/9mcg £19.00 60 doses
Cost effective dry powder formoterol/budesonide.
All strengths licensed for asthma and COPD and has asthma MART licence at lower strength 160/4.5 only

Asthma, under 12 years, not recommended.
COPD, under 18 years, not recommended.
Duoresp® Spiromax
Budesonide/formoterol
Dry powder inhaler
Green Footprint
160mcg/4.5mcg: £27.97
(120 doses)
320mcg/9mcg: £27.97
(60 doses)
New legislation demands that delivered dose is stated. 160/4.5 is comparative to Symbicort 200/6, and 320/9 is comparative to 400/12. Can be used as maintenance or maintenance and reliever therapy. License in asthma and COPD (COPD 320/9mcg twice a day dose). Licensed 12yrs and above. SPC for Duoresp suggests that stepdown from 160/4.5 may require separation into separate inhalers but does not preclude single daily dose regimen if considered clinically appropriate
Symbicort®
Turbohaler

(Budesonide /
Formoterol)
Dry-powder inhaler
Green Footprint
100mcg/6mcg: £28.00
(120 doses)
200mcg/6mcg: £28.00
(120 doses)
400mcg/12mcg: £28.00
(60 doses)
Licensed in asthma and COPD. The 100/6 strength is now licensed in age >6 years. 200/6 licensed 12yrs and above.

Symbicort® Maintenance and Reliever Therapy (SMART): Patients over 12 years who are poorly controlled may also use Symbicort® 200/6 as a rescue medication (maximum 12 puffs per day), with no salbutamol. Careful patient education is required and quantity of inhalers used monitored.

Symbicort 200/6 is now licensed in mild asthma when needed in response to symptoms in patients 12 years and above.
Patients should take one inhalation in response to symptoms. If symptoms persist after a few minutes a further inhalation may be taken. A maximum of 6 inhalations on a single occasion.
Symbicort®
MDI

(Budesonide /
Formoterol) MDI
Red Footprint
200mcg/6mcg: £28.00
(120 doses)

Symptomatic treatment of COPD with a post-bronchodilator FEV1 <70% predicted and a history of exacerbations despite regular bronchodilator therapy.

NB CONTAINS HFA227 WHICH HAS A VERY HIGH CARBON FOOTPRINT
Not licensed in asthma, so no MART licence
Salmeterol/fluticasoneCampona Airmaster®
Dry powder inhaler
Green Footprint
50mcg/100mcg: £7.95 (60 dose)

Campona Airmaster is our cost effective preference in DPI salmeterol/fluticasone inhalers. Licensed in asthma and COPD
50mcg/250mcg: £8.95 (60 dose)
50mcg/500mcg: £9.95 (60 dose)
Fusacomb Easyhaler®
Dry powder inhaler
Green Footprint
50mcg/250mcg: £21.50 (60 dose)
50mcg/500mcg: £26.99 (60 dose)
Fixkoh Airmaster®
Dry powder inhaler
Green Footprint
50mcg/100mcg: £14.47 (60 dose)
50mcg/250mcg: £19.29 (60 dose)
50mcg/500mcg: £16.12 (60 dose)
Seretide Accuhaler®
Dry powder inhaler
Green Footprint
50mcg/100mcg: £17.46 (60 dose)
50mcg/250mcg: £33.95 (60 dose)
50mcg/500mcg: £32.74 (60 dose)
Stalpex®
Dry powder inhaler
Green Footprint
50mcg/500mcg: £16.12 (60 dose)
AirFluSal Forspiro®
Dry powder inhaler
Green Footprint
50mcg/500mcg: £29.97(60 dose) For asthma and COPD.

Adult: one inhalation twice a day.
Sereflo Ciphaler®
Dry powder inhaler
Green Footprint
50mcg/250mcg: £10.99 (60 dose)For asthma.

Adults and adolescents 12 years of age and older: one inhalation twice a day.
50mcg/500mcg: £10.99 (60 dose)
Avenor®
Metered dose inhaler
Red Footprint
25mcg/50mcg: £12.99 (120 dose)For asthma.

Adults and adolescents 12 years and older: two inhalations of 25mcg/125mcg twice daily.

Children 4 years and older: two inhalations of 25mcg/50mcg twice daily.
25mcg/125mcg: £10.33 (120 dose)
25mcg/250mcg: £13.66 (120 dose)
AirFluSal®
Metered dose inhaler
Red Footprint
25mcg/125mcg: £16.42 (120 dose)
For asthma.

Adult: two inhalations of 25mcg/125mcg twice daily.

25mcg/250mcg is non-formulary.
Sereflo®
Metered dose inhaler
Red Footprint
25mcg/125mcg: £14.99 (120 dose)
Sirdupla®
Metered dose inhaler
Red Footprint
25mcg/125mcg: £22.45 (120 doses)
Combisal®
Metered dose inhaler
Red Footprint
25mcg/50mcg: £13.50 (120 dose)For asthma.

Adult: two inhalations of 25mcg/125mcg twice daily.

Children 4 years and older: two inhalations of 25mcg/50mcg twice daily.

25mcg/250mcg is non-formulary.
25mcg/125mcg: £17.59 (120 dose)
Seretide Evohaler®
Metered dose inhaler
Red Footprint
25mcg/50mcg: £17.46 (120 dose)For asthma.

Adult: two inhalations twice daily.

Children 4 years and older: two inhalations of 25mcg/50mcg twice daily.

25mcg/250mcg is non-formulary.
25mcg/125mcg: £23.45
Formoterol/fluticasoneFlutiform®
Metered dose inhaler
Red Footprint

5mcg/50mcg: £14.40 (120 dose)For asthma.

Adult: two inhalations twice daily.


Children aged 5 years and older: two inhalations of the 5mcg/50mcg twice daily.

10mcg/250mcg is non-formulary.
5mcg/125mcg: £28.00 (120 dose)
Formoterol/beclometasoneBibecfo®
Metered dose inhaler
Red Footprint
6mcg/100mcg: £13.98 (120 dose) For asthma and COPD.

Adult: one or two inhalations twice a day.
6mcg/200mcg: £13.98 (120 dose)
Luforbec®
Metered dose inhaler
Red Footprint
6mcg/100mcg: £13.98
(120 dose)
6mcg/200mcg: £13.98
(120 dose)
Fostair®
Metered dose inhaler
Red Footprint



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.
6mcg/200mcg: £29.32
(120 dose)
Fostair NEXThaler®
Dry powder inhaler
Green Footprint
6mcg/100mcg: £29.32
(120 dose)
6mcg/200mcg: £29.32
(120 dose)
Indacaterol/mometasoneAtectura Breezhaler®
Dry powder inhaler
Green Footprint
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/fluticasoneRelvar Ellipta®
Dry powder inhaler
Green Footprint
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)
Triple component inhalersTrelegy Ellipta®
Vilanterol/fluticasone furoate/umeclidinium
22 microgram/92 microgram/55 microgram per inhalation,
DPI device
Green Footprint
£44.50 (30 dose)Maintenance treatment of moderate to severe COPD where an inhaled corticosteroid plus a LABA is inadequate
Adults:1 puff once daily.
Children: Under 18 years, not recommended.
Enerzair Breezhaler®
Indacaterol/mometasone/glycopyrronium 114 microgram/136 microgram/46 microgram per inhalation,
DPI device
Green Footprint
£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.
One puff daily
18 years and above only
Trimbow Nexthaler®
Beclometasone 88 mcg, Formoterol 5 mcg, glycopyrronium 9mcg per puff
DPI device
Green Footprint
£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
Please note: this is a 2p bd dosage


Not licensed in asthma
Trimbow®
Beclometasone 87 mcg, Formoterol 5 mcg, glycopyrronium 9mcg per puff
MDI device
Red Footprint
£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.
This is a fixed 2p bd dosage

Trimbow®
Beclometasone 172 mcg, Formoterol 5 mcg, glycopyrronium 9mcg per puff
MDI device
Red Footprint
£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.

Please note: this is a 2p bd dosage

Trixeo Aerosphere®
Budesonide 160 mcg, Formoterol 5 mcg, glycopyrronium 9mcg per puff
MDI device
Red Footprint
£44.50 (120 dose)Introduced in January 2021. Trixeo Aerosphere is indicated as a 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.
Dose is 2 puffs bd = medium ICS dose
Spacer devicesPatient'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

Categorisation of inhaled corticosteroids by dose (BTS/SIGN guideline on the management of asthma 2019)