1. COPD PATHWAY AND PRESCRIBING POLICY IN LAMA options (stop SAMA):
PRIMARY CARE
Inhaler technique
-check inhaler technique
and compliance at
every opportunity
-use dry powder inhaler
if able (use Incheck
device to check flow rate
30-90L/minute)
-MDIs should be used
with a spacer
Confirmed diagnosis
of COPD
Smokers
-ask about smoking at
every opportunity and
refer to smoking cessation
services
SABA options:
-salbutamol 100mcg MDI + spacer PRN (200 doses £1.50)
-salbutamol 100mcg Easyhaler PRN (200 doses £3.31)
-salbutamol 100mcg Easi-Breathe PRN (200 doses £6.30)
-terbutaline 500mcg Turbohaler PRN (100 doses £6.92)
-salbutamol 200mcg Accuhaler (60 doses £3.00)
SAMA
-ipratropium 20mcg MDI + spacer PRN (200 doses £5.05 )
SABA or SAMA
As required
Still symptomatic on SABA
Referral to
pulmonary
rehabilitation
-breathless on
walking <200m
-Solihull CCG
refer to
community
respiratory team
for
pulmonary rehab
Add LAMA
(stop SAMA)
LAMA options (stop SAMA):
First line
- ▼glycopyrronium Breezhaler 1 puff OD (£335 p.a)
Second line
- tiotropium Handihaler 18mcg 1 puff OD (£409 p.a)
- ▼tiotropium Respimat 2.5mcg 2 puffs OD (£432 p.a)
LABA options:
formeterol Easyhaler 12mcg 1 puff BD (£144 p.a)
formoterol MDI 12mcg 1 puff BD (£202 p.a)
-formeterol Turbohaler 12mcg 1 puff BD (£302 p.a)
-salmeterol Accuhaler 50mcg 1 puff BD (£356 p.a)
-salmeterol MDI 25mcg 2 puffs BD + spacer (£361 p.a)
FEV1 ≥50%
FEV1 <50%
Persistent breathlessness or exacerbations
Persistent breathlessness alone
Exacerbations +/- persistent breathlessness
Add LABA + ICS
combination
Add LABA
Self management
-ensure patient has a
COPD action plan
Persistent breathlessness or exacerbations
Combination LABA and ICS options:
First line
-Symbicort Turbohaler 400/12 1 puff BD (£462 p.a)
Second line
-Seretide Accuhaler puff BD (£491 p.a)
-Fostair 100/6 2 puffs BD + spacer (£356 p.a)
Add ICS to
current LABA
Immunisation
-Pneumococcal vaccination
and influenza vaccination
should be offered to all
patients with COPD