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Inhaled therapy for copd

Guidance for Inhaled Therapy for COPD
Breathlessness and
Glossary
SABA or SA
Exercise limitation
MA as required
SABA = Short Acting Beta Agonist
SABA: (may continue at all stages)
LABA = Long Acting Beta Agonist
SAMA = Short Acting Antimuscarinic
LAMA = Long Acting Antimuscarinic
ICS = Inhaled Corticosteroid
MDI = Metered Dose Inhaler
DPI = Dry Powder Inhaler
Exacerbations or
Pulmonary Rehabilitation
persistent breathlessness
1 < 50%
Offer to ALL patients who
consider themselves functionally
disabled
Contraindicated/
Contraindicated/
(Usually MRC grade 3 and above)
Not tolerated
Not tolerated
DPI – 1. Formoterol Easyhaler® 12mcg BD In a combination inhaler
(Indacaterol is considered 3rd line for those (** Respimat® not recommended – unable to tolerate other LABAs, use other 2. Seretide® 500 Accuhaler® 1 puff BD MDI – 1. Fostair® 100/6 2 puffs BD*
2. Seretide® 250 Evohaler® 2 puffs BD*
Mucolytics
LABA + ICS
Consider if patient has a chronic sputum
In a combination inhaler
TRIPLE THERAPY
producing cough.
Consider before increasing inhaled therapy. 2. Seretide® 500 Accuhaler® 1 puff BD Continue only if there is symptomatic
MDI – 1. Fostair® 100/6 2 puffs BD*
LABA + ICS
improvement.
2. Seretide® 250 Evohaler® 2 puffs BD*
In a combination inhaler
1. Carbocisteine 375mg capsules 2. Mecysteine 100mg tablets Persistent exacerbations or
DO NOT routinely use mucolytics to prevent
breathlessness
exacerbations in people with stable COPD.
Choose a drug based on the person’s symptomatic response and pref erence, the drug’s side effects, potential to reduce exacerbations and cost. DO NOT use oral corticosteroid reversibility tests to identify patients who
will benefit from inhaled corticosteroids. Be aware of the potential risk of developing side effects (including an increased risk of non-fatal pneumonia) in people with COPD treated with inhaled corticosteroids and be prepared to discuss this with patients. = Less strong evidence for this treatment pathway option. * Fostair® and Seretide® 250 Evohaler® are unlicensed for COPD but are options where an MDI is considered clinically appropriate,
Based on: NICE. Chronic obstructive pulmonary disease: management of chronic obstructive pulmonary disease in adults in primary and secondary care. NICE clinical guideline 101 (Partial update of CG12). June 2010, and local consensus. Inhaled Therapy for COPD VERSION 2.0 August 2012

Source: http://healtheastcic.co.uk/QuickPages/Uploads/TAG%20Sept%202012%20Item%206.3%20-%20Inhaled%20Therapy%20for%20COPD%20NHS%20NW%20FINAL%20Version%202%200%20August%202012.pdf

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