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
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Guidance for Inhaled Therapy for COPD