SABA (short acting beta agonist) inhalers Aerosol InhalersGeneric Component No of doses Cost/ device Dosing directions Ventolin evohalerSalbutamol 100mcg/dose200£ puffs up to 4 times a day Salamol easibreatheSalbutamol 100mcg/dose200£ puffs up to 4 times a day Airomir autohalerSalbutamol 100mcg/dose200£ puffs up to 4 times a day Dry Powder InhalersGeneric Component No of doses Cost/ device Dosing directions Easyhaler salbutamolSalbutamol 100mcg/dose200£ puffs up to 4 times a day Ventolin AccuhalerSalbutamol 200mcg/dose60£3.001 puff up to 4 times a day Bricanyl turbohalerTerbutaline 500mcg/dose100£6.921 puff up to 4 times a day Prepared by Jacqueline Coleman Prescribing Adviser Stockport CCG Aug 2015 Prices from Mims online

SAMA (short acting muscarinic antagonist ) inhalers Aerosol Inhaler Generic Component No of dosesCost/deviceDosing directions Licensed indications Formulary Y/N Atrovent © Ipratropium 20mcg 200£ puffs three or four times daily COPD Asthma y Prepared by Jacqueline Coleman Prescribing Adviser Stockport CCG Aug 2015 Prices from Mims online

LAMA (long acting muscarinic antagonist ) inhalers Dry Powder Inhalers Brand name/device name Generic Component No of doses Cost/ device Dosing directions Licensed indications Formulary Y/N Eklira Genuair © Aclidinium 322mcg 60£ puff twice daily COPDY Incruse Ellipta © Umeclidinium 55mcg 30£ puff dailyCOPDN Seebri Breezhaler © Glycopyrronium 50mcg 30£ cap dailyCOPDY Spiriva Handihaler © Tiotropium 18mcg caps 30£ dailyCOPDY 1 st choice LAMA Aerosol InhalersGeneric Component No of doses Cost/ device Dosing directions Licensed indications Formulary Y/N Spiriva Respimat © Tiotropium 2.5mcg 60£ puffs once daily COPD Asthma Y 1 st choice LAMA Prepared by Jacqueline Coleman Prescribing Adviser Stockport CCG Aug 2015 Prices from Mims online

LABA (long acting beta agonist) inhalers – DPI (dry powder) devices Brand /Inhaler type Generic Component No of doses Cost/ device Dosing directionsLicensed indication Formulary Y/N Easyhaler © Formoterol Oxis turbohaler © Formoterol 12mcg Formoterol 6mcg 12mcg £23.75 £ p twice daily 1 or 2puffs daily COPD Asthma Y 1 st choice LABA Onbrez Breezhaler © Indacaterol 150mcg 300mcg 30 £ cap dailyCOPDY Serevent © Accuhaler Salmeterol 50mcg60£ puff twice dailyCOPD Asthma y Prepared by Jacqueline Coleman Prescribing Adviser Stockport CCG Aug 2015 Prices from Mims online

LABA (long acting beta agonist) inhalers –MDI aerosol devices Brand/ Inhaler type Generic Components No of doses Cost/ device Dosing directions Licensed indications Formulary Y/N Serevent © evohaler Salmeterol 25mcg120£ puff twice daily COPD and Asthma Y Striverdi © Respimat Olodaterol 2.5mcg60£ puffs once daily COPDN (GMMMG status- low priority for funding) Prepared by Jacqueline Coleman Prescribing Adviser Stockport CCG Aug 2015 Prices from Mims online

LABA/LAMA Combination Inhalers (probably best used in mild to moderate disease where symptoms continue after using a LABA or LAMA alone) Inhaler Name /type Brand nameGeneric Components No of doses Cost/ device Dosing directions Licensed indicatio n Formulary Y/N Ellipta © /DPIAnoro © Vilanterol 22mcg/ Umeclidinium 55mcg 30£ puff dailyCOPDY Genuair © /DPIDuaklir © Formoterol 12mcg/ Aclidinium 340mcg 60£ puff twice daily COPDy Breezhaler © /DPIUltibro © Indacaterol 110mcg/ Glycopyrronium 50mcg 30£ cap dailyCOPDy Respimat © /MDISpiolto © Olodaterol 2.5mcg/ Tioptropium 2.5mcg 60£ puffs once daily COPDY Prepared by Jacqueline Coleman Prescribing Adviser Stockport CCG Aug 2015 Prices from Mims online

LABA/ICS Combination inhalers –Aerosol MDI devices Probably best used in moderate to severe disease (in copd consider where FEV1 < 50% and 2 or more exacerbations in last 12 months or where combination of LABA and LAMA still does not control symptoms) Aerosol inhalerGeneric components No of doses Cost/ device Dosing directionsLicensed Indication Formular y Y/N Flutiform © Formoterol/ Fluticasone 5mcg/50mcg 5mcg/125mcg 10mcg/250mcg 120£18 £29.26 £ puffs twice dailyAsthma – only (from age 12 years) Y Fostair © Formoterol 6mcg/ Beclometasone 100mcg 120£ puffs twice daily 1-2 puffs twice daily COPD Asthma (from age 18 years) Y Seretide © evohalerSalmeterol/ Fluticasone 25mcg/50mcg 25mcg/125mcg 25mcg/250mcg 120£18 £35 £ puffs twice dailyAsthma – only (from age 4years) Y Sirdupla © Salmeterol/ Fluticasone 25mcg/125mcg 25mcg/250mcg 120 £26.25 £ puffs twice dailyAsthma – only (from age 18 years) Branded generic Prepared by Jacqueline Coleman Prescribing Adviser Stockport CCG Aug 2015 Prices from Mims online

LABA/ICS Combination inhalers –Dry powder devices Probably best used in moderate to severe disease (in copd consider where FEV1 < 50% and 2 or more exacerbations in last 12 months or where combination of LABA and LAMA still does not control symptoms) Dry Powder InhalersGeneric Components No of doses Cost/ device Dosing directionsLicensed indications Formulary Y/N Duoresp Spiromax © 160/ /9 Formoterol/budesonide 6mcg/200mcg 12mcg/400mcg 60 £29.97 Varies depending on strength used and condition COPD and Asthma Y Fostair Nexthaler © Formoterol 6mcg/ Beclometasone 100mcg 120£ puffs twice dailyAsthma - only Branded Generic Seretide © Accuhaler 100, 250, 500 Salmeterol/Fluticasone 50mcg/100mcg 50mcg/250mcg 50mcg/500mcg 60 £18 £35 £ puff twice dailyCOPD Asthma –all strengths Y Symbicort © Turbohaler 100,200,400 Formoterol/Budesonide 6mcg/100mcg 6mcg/200mcg 12mcg/400mcg £33 £38 Varies depending on strength used and condition COPD -200 and 400 Asthma- all strengths Y Relvar Ellipta © Vilanterol/fluticasone 22mcg/94mcg 22mcg/168mcg 30 £27.80 £ puff daily COPD and Asthma Y Prepared by Jacqueline Coleman Prescribing Adviser Stockport CCG Aug 2015 Prices from Mims online

ICS (inhaled corticosteroid) inhalers –only licensed for use in asthma MDI aerosol Inhalers (name of steroid) Cost of DevicesNo of dosesDosing directions Clenil Modulie © (beclometasone) for children and adults Strength/ dose 50mcg £ mcg £ mcg £ mcg £ or2 puffs up twice daily (specify dose) Qvar © (extra fine particle beclometasone) For age 12 years and over pMDI easibreathe autohaler (note twice as potent as Clenil dose for dose) Strength pMDI easibreathe autohaler /dose 50mcg £7.87 £7.74 £ mcg £17.21 £16.95 £ or2 puffs twice daily (specify dose) Dry Powder Inhalers (name of steroid) Cost of DevicesNo of dosesDosing directions Easyhaler © (beclometasone) (budesonide) Strength/dose Beclometasone Budesonide 200mcg 100mcg 200mcg 400mcg £14.93 £8.86 £17.21 £ or2 puffs twice daily (specify dose) Turbohaler © (budesonide) Strength/dose 100mcg 200mcg 400mcg £11.84 £11.84 £ ,100,50 1 or 2 puffs twice daily (Specify dose) Prepared by Jacqueline Coleman Prescribing Adviser Stockport CCG Aug 2015 Prices from Mims online