East Sussex - Better Together
NHS

COPD Inhaler chart

Go here for Pictorial guide of inhalers commonly prescribed in COPD.

  • Formulary inhalers = Green

  • Non-formulary = greyed out

Triple therapy inhalers (Trelegy Ellipta and Trimbow MDI + spacer)

Triple therapy inhalers containing ICS/LAMA/LABA should only be initiated on the recommendation of a senior respiratory clinician or the practice respiratory lead, in view of the increased risk of pneumonia with ICS and the requirement to assess efficacy of both LAMA and LABA for the patient.

GOLD guidelines (which are more comprehensive and up to date than the NICE COPD guideline) advocate triple therapy only for patients in category D:

  • MRC≥2
  • high CAT score (≥10)
  • frequent exacerbations (≥ 2 in previous 12 months, or one at any time requiring hospitalisation)

All patients should have previously been referred to pulmonary rehabilitation as this is a more effective intervention.
Current smokers are unlikely to benefit from triple inhaler as the benefits of ICS are reduced.
The Rightbreathe website is a useful resource for information on the place in therapy of all inhalers: https://www.rightbreathe.com.
The COPD Care Pathway can be found on DXS in: ‘Respiratory section’ – ‘Care pathway’ - or directly by searching "COPD care".

  • First Line Drugs
  • Second Line Drugs
  • Specialist Initiated Drugs
  • Specialist Only Drugs
  • Mixed Status