Treatment alternatives

NICE recommendations for using inhaled treatments for chronic obstructive pulmonary disease (COPD) are outlined in the introduction to this evidence summary.

Three single-component long-acting beta2 agonists (LABAs) are currently licensed for treating COPD in the UK: formoterol, indacaterol and salmeterol. Single-component long-acting muscarinic antagonists (LAMAs) licensed for treating COPD are aclidinium, glycopyrronium and tiotropium.

There are also 2 combined inhaled corticosteroid (ICS) and LABA inhalers that are currently licensed for treating COPD in the UK:

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

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

Costs of treatment alternatives

The indacaterol/glycopyrronium combination inhaler is expected to be less expensive than the combined cost of the single-component inhalers (indacaterol £29.26, glycopyrronium £27.50 for 30-days' treatment).


Usual dosage a,b

30-day cost excluding VAT c

Single-component LABAs

Formoterol fumarate 12 micrograms (Foradil)d

1 puff twice daily


Indacaterol maleate 150 and 300 micrograms (Onbrez Breezhaler)

1 puff daily


Salmeterol xinafoate 50 micrograms (Serevent Accuhaler)d

1 puff twice daily


Single-component LAMAs

Aclidinium bromide 322 micrograms (Eklira Genuair)

1 puff twice daily


Glycopyrronium bromide 50 micrograms (Seebri Breezhaler)

1 puff daily


Tiotropium bromide 18 micrograms, dry powder (Spiriva Handihaler)

1 puff daily


Tiotropium bromide 2.5 micrograms, aerosol (Spiriva Respimat)

2 puffs daily


Combination ICS/LABA inhalers

Fluticasone propionate/salmeterol xinafoate 500/50 micrograms (Seretide 500 Accuhaler)

1 puff twice daily


Budesonide/formoterol fumarate 200/6 micrograms (Symbicort Turbohaler 200/6)

2 puffs twice daily


Budesonide/formoterol fumarate 400/12 micrograms (Symbicort Turbohaler 400/12)

1 puff twice daily


Abbreviations: ICS, inhaled corticosteroid; LABA, long-acting beta2 agonist; LAMA, long-acting muscarinic antagonist.

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 the Drug Tariff (January 2013) except aclidinium, glycopyrronium and tiotropium Respimat (MIMS, December 2013). All costs include the inhaler device.

d Lowest cost dry powder formulations selected; other brands and formulations are available.