3.2 Corticosteroids

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Key message in Asthma - BTS/SIGN Guidelines

Don't skip a step - When introducing inhaled steroids for the first time after Step 1, do not move straight to Step 3 (i.e. combination of inhaled steroids and LABA) without first introducing low dose beclomethasone alone at Step 2. Long acting beta agonists (LABA) may not give any additional benefit, and have less long-term safety data to support their use. They should therefore be added in separately at Step 3 on a trial basis, reviewed, and stopped if there is no improvement.

Key message in COPD

In chronic obstructive pulmonary disease (COPD) inhaled corticosteroid treatment may reduce exacerbations. An inhaled corticosteroid (unlicensed indication) should be considered (in addition to bronchodilator treatment) if the forced expiratory volume in 1 second (FEV1) is less than 50% of the predicted value and if the patient has had two or more exacerbations in a year whick require antibacterial treatment or an oral corticosteroid.

Licensed preparations for COPD, Relvar Ellipta 92/22, Symbicort 200/6 Turbohaler, Symbicort 400/12 Turbohaler, Seretide 500 Accuhaler, Fostair 100/6.


British Thoracic Society/SIGN  Asthma Guidelines   
NICE CG101 COPD Jun 10 
TA138 Asthma (in adults) - corticosteroids Mar 08

BECLOMETHASONE  - Beclomethasone is the preferred first line inhaled corticosteroid.

  BECLOMETASONE MDI / Easi-breathe     (Qvar Easi-breathe  / Clenil Modulite      
      Beclometasone dipropionate CFC-free pressurised metered-dose inhalers (Qvar® and Clenil Modulite®) are not interchangeable and should be prescribed by brand name; Qvar® has extra-fine particles, is more potent than traditional beclometasone dipropionate CFC-containing inhalers, and is approximately twice as potent as Clenil Modulite®


    BECLOMETASONE / FORMOTEROL    (Fostair inc Nexthaler) 


    BUDESONIDE Turbohaler / neb     


        BUDESONIDE / FORMOTEROL As per COPD and adult asthma guideline ONLY     
1st      DuoResp Spiromax    
2nd      Symbicort    


      FLUTICASONE MDI / Accuhaler   



1st        FLUTIFORM (fluticasone / formoterol 50/5,125/5,250/10)    
2nd      FLUTICASONE / SALMETEROL MDI / Accuhaler (Seretide)  




        FLUTICASONE / VILANTEROL (as trifenatate) 92/22 (Relvar Ellipta)   


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