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Bedfordshire and Luton Joint Formulary
Bedfordshire Hospitals NHS Foundation Trust
Bedfordshire, Luton and Milton Keynes ICB
Formulary Chapter: 3 - Respiratory system 
Notes:

Any drug not listed on the Formulary should be considered Non-Formulary - Not recommended for prescribing
Links:
BLMK ICB Guidance: Chronic obstructive pulmonary disease guidelines for primary care BLMK ICB Guidance: Review of Inhaled Corticosteroids (ICS) in patients with COPD BLMK Paediatric Wheeze and Asthma Guidelines (Children Age 16 and under), Oct 2024 NICE NG115: COPD guideline NICE NG78: Cystic fibrosis: diagnosis and management. October 2017 Right Breathe Inhaler Prescribing Information
03.02 Corticosteroids
Asthma: diagnosis, monitoring and chronic asthma management (BTS, NICE, SIGN) BLMK Asthma Guidelines for Adults in Primary Care BLMK Chronic Obstructive Pulmonary Disease (COPD) Primary Care Guidelines BLMK Review of Inhaled Corticosteroids (ICS) in patients with COPD NICE guideline [NG115] Chronic obstructive pulmonary disease in over 16s: diagnosis and management

Beclometasone Dipropionate (Clenil Modulite®)
(CFC-free aerosol inhalation)

GREEN
First Choice

50microgram, 100microgram, 200microgram & 250microgram per metered dose Red Footprint

BNF BNFc SPC

Beclometasone Dipropionate (Easyhaler Beclometsone®)
(DPI)

GREEN
First Choice

200microgram per metered dose dry powder inhaler Green Low Carbon

Low carbon option

BNF BNFc SPC

Beclometasone (Qvar®)
(CFC-free aerosol inhalation)

GREEN
Second Choice

Qvar and Clenil Modulite are NOT interchangeable and should be prescribed by brand name. Qvar has extra-fine particles and is approximately twice as potent as Clenil Modulite

50micrograms & 100micrograms per metered inhalation (MDI) Red High carbon footprint
100micrograms per metered dose - AutohalerRed High carbon footprint

BNF BNFc SPC

Fluticasone propionate (Flixotide®)

GREEN
Second Choice

50, 125, 250 micrograms EvohalerRed Footprint
50, 100, 250, 500 micrograms dry powder inhaler (Accuhaler)Green Footprint

N.B. Most expensive of the steroid inhalers.

BNF BNFc SPC

Beclometasone and formoterol (Fostair NEXThaler®)
(Dry Powder Inhaler)

GREEN
Formulary

Corticosteroid and long-acting beta agonist (ICS/LABA).

Fostair has extra-fine particles and is more potent than traditional beclometasone dipropionate CFC inhalers.

Beclometasone 100microgram/Formoterol 6microgram per metered dose

 Green Footprint

Beclometasone 200microgram/Formoterol 6microgram per metered dose

 Green Footprint

Entry reviewed: September 2022

BNF BNFc SPC

Beclometasone and formoterol MDI (Proxor®, Luforbec® and Fostair®)
(CFC-free aerosol inhalation)

GREEN
Formulary

Available strengths:

100/6 (licensed for MART*)

200/6

 

Cost effective brand:

  • Proxor (preferred) Red Footprint
  • Luforbec Red Footprint

 

Other brands on Formulary:

  • Fostair Red Footprint

  

*MART = Maintenance And Reliever Therapy

 

Licensed for MART from 18+yrs.  Also recommended off-label use for AIR in the BLMK asthma guidelines for 18yrs+.

 

Entry updated: July 2025

BNF BNFc SPC

Beclometasone, formoterol & glycopyrronium (Trimbow 87/5/9® )
(MDI )

GREEN
Formulary

(ICS / LAMA/ LABA) for the treatment of COPD

Restricted ItemCOPD MDI choice for those unable to manage DPI. Restricted for those who have failed dual therapy – refer to COPD guidelines.

Red Footprint

NB: The 172/5/9 strength is not licensed for COPD

 Entry reviewed: September 2022

 

BNF BNFc SPC

Beclometasone, formoterol & glycopyrronium (Trimbow NEXThaler 88/5/9)
(Dry powder inhaler for COPD)

GREEN
Formulary

Restricted Item COPD DPI choice. Restricted for those who have failed dual therapy – refer to COPD guidelines.

Green Footprint

 Entry reviewed: December 2024

BNF BNFc SPC

Beclometasone, formoterol & glycopyrronium (Trimbow® for asthma indication)
(MDI)

Amber SPA
Formulary

Asthma (license extension)

Speciaist initiation and then can be continued by GP.

 Strengths available: 87/5/9 and 172/5/9

Red Footprint

BNF BNFc SPC
BLMK Asthma Guidelines for Adults in Primary Care

Budelin Novolizer®

GREEN
Formulary

Novoliser (DPI) 200 micrograms

Inhaled Cortocosteroids (ICS) - Important notes:
The lowest possible dose should be prescribed to maintain therapeutic effect. The total daily dose of inhaled corticosteroids should rarely be increased above:
Children: 800 micrograms beclometasone or budesonide; 400 micrograms fluticasone.
Adults: 2000 micrograms beclometasone or budesonide; 1000 micrograms fluticasone or Qvar.

 

Entry reviewed: April 2023

BNF BNFc SPC

Budesonide (Pulmicort Respules®)
(Nebuliser Suspension)

RED
Formulary
0.5mg & 1mg in 2mL Nebules
BNF BNFc SPC

Budesonide (Pulmicort Turbohaler®)
(Dry Powder Inhaler)

GREEN
Formulary

100microgram, 200microgram & 400microgram per metered dose. Green Low Carbon

BNF BNFc SPC

Budesonide and formoterol (DuoResp Spiromax®)
(Dry Powder Inhaler)

GREEN
Formulary

Budesonide 160microgram / formoterol 4.5microgram: equivalent to a metered dose of 200microgram budesonide / 6microgram formoterol. Licensed for MART and AIR (anti-inflammatory reliever) therapy in 12yrs+.

Budesonide 320microgram / formoterol 9microgram: equivalent to a metered dose of 400microgram budesonide / 12microgram formoterol.


Green Low Carbon 

Entry reviewed: September 2022

BNF BNFc SPC

Budesonide and formoterol (Fobumix®)
(Dry Powder Inhaler)

GREEN
Formulary

Corticosteroid and long acting beta agonist (ICS/LABA). 80/4.5, 160/4.5, 320/9 micrograms per delivered dose

 

licensed for MART and AIR (anti-inflammatory reliever) therapy in 12yrs+.

Green Low Carbon

BNF BNFc SPC

Budesonide and formoterol (Symbicort Turbohaler®)
(Dry Powder Inhaler)

GREEN
Formulary

Corticosteroid and long acting beta agonist (ICS/LABA).

100microgram/6microgram 
200microgram/6microgram 
400microgram/12microgram 

Green Low Carbon

Some adult asthma patients may benefit from using Symbicort® as Maintenance And Reliever Therapy (SMART)

Allowing patients to increase dose when their asthma worsens, avoiding the need for multiple inhalers.

Only suitable for patients aged 12 years and above where treatment with a combination of inhaled corticosteroid and LABA agonist is appropriate.

Symbicort 400/12 is not licensed for use in this way.

 

Symbicort 200/6 Turbohaler is also indicated as reliever therapy for adults and adolescents (12 years and older) with mild asthma

 

Entry reviewed: April 2023

BNF BNFc SPC

Budesonide and formoterol (Symbicort®)
(CFC-free aerosol inhalation)

GREEN
Formulary

Corticosteroid and long acting beta agonist (ICS/LABA).

200 microgram/6 microgram per metered dose (MDI)

 Red Footprint

Some adult asthma patients may benefit from using Symbicort® as Maintenance And Reliever Therapy (SMART)

Allowing patients to increase dose when their asthma worsens, avoiding the need for multiple inhalers.

Only suitable for patients aged 12 years and above where treatment with a combination of inhaled corticosteroid and LABA agonist is appropriate.

 

Entry reviewed: September 2022

BNF BNFc SPC

Budesonide Easyhaler®

GREEN
Formulary

Budesonide Easyhaler® (DPI) 100, 200, 400 microgram per inhalation

Under 6 years, not recommended

 

Inhaled Cortocosteroids (ICS) - Important notes:
The lowest possible dose should be prescribed to maintain therapeutic effect. The total daily dose of inhaled corticosteroids should rarely be increased above:
Children: 800 micrograms beclometasone or budesonide; 400 micrograms fluticasone.
Adults: 2000 micrograms beclometasone or budesonide; 1000 micrograms fluticasone or Qvar.

 

Entry reviewed: March 2023

BNF BNFc SPC

Fluticasone 92 micrograms/ umeclidinium 55 micrograms/ vilanterol 22 micrograms (Trelegy Ellipta®)
(dry powder inhaler)

GREEN
Formulary

Restricted ItemCOPD DPI choice. Restricted for those who have failed dual therapy – refer to COPD guidelines.

 Green Low Carbon

Entry reviewed: September 2022

 

BNF BNFc SPC

Fluticasone furoate & vilanterol (Relvar Ellipta®)

GREEN
Formulary

Green Low Carbon

 

BNF BNFc SPC

Fluticasone propionate and formoterol (Flutiform®)
(Pressurised Inhaler, suspension)

GREEN
Formulary

Corticosteroid and long-acting beta agonist (ICS/LABA).

125microgram fluticasone/ 5microgram formoterol
250microgram fluticasone/ 10microgram formoterol

Red High carbon footprint Highest carbon footprint of all inhalers

BNF BNFc SPC

Fluticasone propionate and salmeterol

GREEN
Formulary

Corticosteroid and long acting beta agonist (ICS/LABA).

100microgram, 250microgram & 500microgram AccuhalerGreen Footprint
50microgram, 125microgram & 250microgram EvohalerRed Footprint

  • Seretide Accuhaler is licensed for COPD but the Evohaler is not - many patients with COPD are using the Seretide 250 Evohaler.  The cost of Seretide Accuhaler 500 (One Puff bd) is significantly less than Seretide 250 Evohaler (Two Puffs bd)

Hospitals: contract brand will be supplied (Seretide).

Primary care: Most cost effective brand to be advised via OptimiseRx

BNF BNFc SPC

Formoterol 5 micrograms / glycopyrronium 7.2 micrograms / budesonide 160 micrograms (Trixeo Aerosphere ®)

GREEN
Formulary

 

Restricted ItemCOPD MDI choice. Restricted for those who have failed dual therapy – refer to guidelines.

Green Footprint

Entry reviewed: November 2025

BNF BNFc SPC
Non formulary items

salmeterol xinafoate / fluticasone propionate DPI (Fixkoh Airmaster)

DNP
Non Formulary

Assessed November 2022. Fixkoh Airmaster was not added to the Formularies.

BNF BNFc SPC
Classifications
GREEN
May be initiated in any care setting
Amber SPA
Specialist to advise therapy and provide first 28 days supply, continuation in Primary Care
Amber SPIS
Specialist to initiate and stabilise medicine prior to continuation in Primary Care
SCG
To be prescribed as per Shared Care Guidance. If no SCG in place status reverts to red.
RED
Red medicines are designated as specialist only medicines which should only be prescribed by a specialist, usually within secondary care (either due to the requirement for specialist knowledge, long-term monitoring requirements, or restrictions that mean medicine supplies are only available to hospitals).
DNP
A decision has been made either locally and/or nationally not to routinely commission this preparation. Do not prescribe.
SELF
To be purchased over the counter. May be prescribed for chronic, long term conditions or on admission to hospital if essential.