Adult asthma dry powder formulary pathway

Warning

Step 1 - Regular low dose inhaled steroid

Formulary Choices:
Easyhaler Beclometasone 200mcg 1 Puff BD (£4.48) or
Easyhaler Budesonide 200mcg 1 puff BD (£5.31)

Equivalents - Non-Formulary:
Pulmicort Turbohaler 100mcg 2 puffs BD (£7.10)
Fluticasone Accuhaler 100mcg 1 puff BD (£8.93)
Asmanex Twisthaler 200mcg 1 puff BD (£23.54)

Step 2 – Add regular long acting beta agonist (LABA) – Fixed dose or MART

Formulary Choices:
Swap to Fostair Nexthaler 100/6
1 puff BD (£14.66)
Swap to DuoResp Spiromax 160/4.5
1 puff BD (£13.98)
OR Fobumix Easyhaler 160/4.5 1 puff BD (£10.75)

Equivalents - Non Formulary:
Add Easyhaler Formoterol 1 puff BD (£11.88)
Symbicort 200/6 1 puff BD (£14.00)
Seretide 100 Accuhaler 1 puff BD (£18.00)
Relvar Ellipta 92/22 1 puff daily (£22.00)

Note:
Qvar, Fostair, Flixotide, Flutiform, Seretide and Asmanex are ‘double strength’ compared to standard Beclometasone (Prices from step 2 per 30 days supply)

Step 3 – Increase to medium dose inhaled steroid

Formulary Choices:
Fostair Nexthaler 100/6
2 puffs BD (£29.32)

DuoResp SpiroMax 160/4.5
2 puffs BD (£27.97)
OR Fobumix Easyhaler 160/4.5 2 puffs BD (£21.50)

Equivalents - Non Formulary:
Beclometasone 400mcg BD plus LABA
Symbicort 400/12 1 puff BD (£28.00)
Seretide 250 Accuhaler 1 puff BD (£35.00)
Fusacomb Easyhaler 250 1 puff BD (£21.50)
Relvar Ellipta 184/22 1 puff daily (£29.50)

Note:
Qvar, Fostair, Flixotide, Flutiform, Seretide and Asmanex are ‘double strength’ compared to standard Beclometasone (Prices from step 2 per 30 days supply)

Step 4 – Review diagnosis - referral/discussion with specialist before increase to high dose inhaled steroid

Formulary Choices:
Fostair Nexthaler 200/6
2 puffs BD (£29.32)

DuoResp SpiroMax 320/9
2 puffs BD (£55.94)
OR Fobumix Easyhaler 320/9 2 puffs BD (£43.00)

Equivalents - Non Formulary:
Beclometasone 800mcg BD plus LABA
Symbicort 400/12 2 puffs BD (£56.00)
Seretide 500 Accuhaler 1 puff BD (£40.92) – also available as AirfluSal Forspiro (£29.97), Fusacomb Easyhaler 500 (£26.99) and Stalpex 500 DPI (£24.56)

Note:
Qvar, Fostair, Flixotide, Flutiform, Seretide and Asmanex are ‘double strength’ compared to standard Beclometasone (Prices from step 2 per 30 days supply)

Reliever as required - Consider step up if using 3 doses a week or more

Formulary Choice:
Easyhaler Salbutamol 100mcg 2 puffs as required (£3.31)

Editorial Information

Last reviewed: 30/10/2023

Next review date: 30/10/2025

Author(s): Emily Kennedy.

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