Corticosteroids (inhaled)
Drug Safety Update
July 2018: Pressurised metered dose inhalers (pMDI): risk of airway obstruction from aspiration of loose objects
August 2017: Corticosteroids rare risk of central serious chorioretinopathy with local as well as systemic administration
December 2014 : Inhaled and intranasal corticosteroids- risk of psychological and behavioural side effects
July 2008: Inhaled medicines containing corticosteroids- various safety issues
October 2007: Inhaled corticosteroids: pneumonia
National Guidance
NG245: Asthma diagnosis, monitoring and chronic asthma management, November 2017 (updated November 2024)
NG115: Chronic obstructive pulmonary disease in over 16s - diagnosis and management, December 2018 (updated July 2019)
BTS/SIGN British Guideline on the management of asthma
Local Guidance
See here for available local respiratory system guidance
Steroid Treatment Card
Issue a steroid treatment card to people who are using prolonged high doses (more than 1000 micrograms beclomethasone per day, or equivalent) of inhaled corticosteroids (ICS). Also consider the use of a spacer with medium-high dose inhaled ICS (via a metered dose inhaler) for those patients at risk of developing oral candidiasis.
Triple Inhaler Therapy
- Trimbow is now licensed for the treatment of asthma, but this should be specialist initiation only. Trimbow remains available for primary care initiation for the treatment of COPD.
- Trimbow NEXThaler is only licensed for the treatment of COPD.
- Enerzair Breezhaler is only licensed for the treatment of asthma.
Cost-Effective Prescribing
Proxor® (100/6 & 200/6 beclometasone formoterol pMDI) offers a cost-effective prescribing benefit.
Clenil Modulite 50mcg and 250mcg inhalers are due to be discontinued November 2026. No new patients should be initiated. Soprobec® is the only alternative Beclometasone pMDI licensed for use in asthma for patients of all ages.
Clenil Modulite and Qvar are not interchangeable and should be prescribed by brand name
| Pack |
|---|
| 200 dose |
| Pack |
|---|
| 200 dose |
| Pack |
|---|
| 200 dose |
| Pack |
|---|
| 200 dose |
| Pack |
|---|
| 200 dose |
| Pack |
|---|
| 200 dose |
| Pack |
|---|
| 200 dose |
| Pack |
|---|
| 200 dose |
Qvar is not dose equivalent to other beclometasone containing inhalers
| Pack |
|---|
| 200 dose |
Qvar is not dose equivalent to other beclometasone containing inhalers
| Pack |
|---|
| 200 dose |
Qvar is not dose equivalent to other beclometasone containing inhalers
| Pack |
|---|
| 200 dose |
Qvar is not dose equivalent to other beclometasone containing inhalers
| Pack |
|---|
| 200 dose |
Qvar is not dose equivalent to other beclometasone containing inhalers
| Pack |
|---|
| 200 dose |
Contains beclometasone dipropionate and formoterol fumarate dihydrate
Fostair is formulated with extra-fine particles of beclometasone and is more potent than some other formulations. The beclometasone dose in Fostair is equivalent to Qvar.
Cost-Effective Prescribing
Proxor® (100/6 & 200/6 beclometasone formoterol pMDI) offers a cost-effective prescribing benefit.
| Pack |
|---|
| 120 dose |
| Pack |
|---|
| 120 dose |
Fostair NEXThaler
| Pack |
|---|
| 120 dose |
Fostair NEXThaler
| Pack |
|---|
| 120 dose |
Contains budesonide and formoterol fumarate dihydrate
Symbicort 100/3 should only be prescribed for children
| Pack |
|---|
| 120 dose |
| Pack |
|---|
| 120 dose |
| 60 dose |
| Pack |
|---|
| 60 dose |
Prescribing for children only
| Pack |
|---|
| 120 dose |
Symbicort Turbohaler
| Pack |
|---|
| 120 dose |
Symbicort Turbohaler
| Pack |
|---|
| 120 dose |
| 60 dose |
| Pack |
|---|
| 120 dose |
Symbicort Turbohaler
| Pack |
|---|
| 60 dose |
Each delivered dose (the dose that leaves the mouthpiece of the Spiromax) contains 160 micrograms of budesonide and 4.5 micrograms of formoterol fumarate dihydrate.
This is equivalent to a metered dose of 200 micrograms budesonide and 6 micrograms of formoterol fumarate dihydrate.
| Pack |
|---|
| 120 dose |
Each delivered dose (the dose that leaves the mouthpiece of the Spiromax) contains 320 micrograms of budesonide and 9 micrograms of formoterol fumarate dihydrate.
This is equivalent to a metered dose of 400 micrograms budesonide and 12 micrograms of formoterol fumarate dihydrate.
| Pack |
|---|
| 60 dose |
Contains fluticasone propionate and formoterol fumarate dihydrate
Flutiform
| Pack |
|---|
| 120 dose |
Flutiform
| Pack |
|---|
| 120 dose |
Flutiform
| Pack |
|---|
| 120 dose |
Contains fluticasone propionate and salmeterol xinafoate
Accuhaler
| Pack |
|---|
| 60 dose |
Accuhaler
| Pack |
|---|
| 60 dose |
Accuhaler
| Pack |
|---|
| 60 dose |
| Pack |
|---|
| 120 dose |
| Pack |
|---|
| 120 dose |
| Pack |
|---|
| 60 dose |
| Pack |
|---|
| 120 dose |
| Pack |
|---|
| 120 dose |
| Pack |
|---|
| 120 dose |
| Pack |
|---|
| 120 dose |
| Pack |
|---|
| 120 dose |
Relvar Ellipta contains fluticasone furoate which is more potent than fluticasone propionate see notes above
| Pack |
|---|
| 30 dose |
| Pack |
|---|
| 30 dose |
Fluticase propionate
| Pack |
|---|
| 120 dose |
| Pack |
|---|
| 120 dose |
| 60 dose |
| Pack |
|---|
| 120 dose |
| 60 dose |
| Pack |
|---|
| 60 dose |
| Pack |
|---|
| 60 dose |
| Pack |
|---|
| 60 dose |
| Pack |
|---|
| 60 dose |
Trimbow is now licensed for the treatment of asthma, but this should be specialist initiation only.
Trimbow remains available for primary care initiation for the treatment of COPD.
Trimbow NEXThaler is licensed for the treatment of COPD.
| Pack |
|---|
| 120 dose |
| Pack |
|---|
| 120 dose |
| Pack |
|---|
| 120 dose |
Licensed for the treatment of asthma only
| Pack |
|---|
| 30 capsule (3 x 10 capsules + 1 sensor) |
| 30 capsule (3 x 10 capsules) |
- On Formulary Preferred
- On Formulary Second Line
- On Formulary Third Line
- Specialist Initiation
- Secondary Care Only
- Not Approved for Formulary