Treatment alternatives

Inhaled treatments for chronic obstructive pulmonary disease (COPD) recommended by NICE are outlined in the introduction.

There are 2 long-acting beta2 agonist (LABA) and inhaled corticosteroid (ICS) combination inhalers currently licensed for use in COPD in the UK:

  • fluticasone propionate/salmeterol 500/50 micrograms dry powder inhalation (Seretide 500 Accuhaler)

  • budesonide/formoterol dry powder inhaler (Symbicort 200/6 Turbohaler and Symbicort 400/12 Turbohaler).

Other combined ICS and LABA inhalers are licensed for use in asthma but not COPD.

Costs of treatment alternatives


Usual dosage a,b

30-day cost excluding VAT c

Fluticasone propionate 500 micrograms/salmeterol 50 micrograms

(Seretide 500 Accuhaler)

1 inhalation twice daily


Budesonide 200 micrograms/formoterol fumarate dihydrate 6 micrograms

(Symbicort Turbohaler 200/6)

2 inhalations twice daily


Budesonide 400 micrograms /formoterol fumarate dihydrate 12 micrograms

(Symbicort Turbohaler 400/12)

1 inhalation twice daily


a Doses taken from the relevant summary of product characteristics.

b The doses shown do not represent the full range that can be used and they do not imply therapeutic equivalence.

c Costs taken from Drug Tariff May 2013.