Treatment alternatives

In people with stable COPD who remain breathless or have exacerbations despite using short-acting bronchodilators as needed, maintenance therapy can be provided by the following (alone or in combination, with choice depending on several factors, see the NICE clinical guideline on COPD for details):

  • a LABA

  • a LAMA

  • a LABA and an ICS in a combination inhaler.

Costs of treatment alternatives


Usual dosage a,b

30-day cost excluding VAT

Glycopyrronium bromide (Seebri Breezhaler)

50 micrograms once daily


Aclidinium bromide (Eklira Genuair)

322 micrograms twice daily


Tiotropium (Spiriva HandiHaler)

18 micrograms daily

£34.87 (refill £33.50)d

Tiotropium (Spiriva Respimat)

5 micrograms daily


Formoterol (Formoterol Easyhaler, Atimos Modulite, Foradil, Oxis Turbohaler)

12 micrograms twice daily

£11.88 to £24.80c,d

Salmeterol (Serevent Accuhaler, Serevent Evohaler, Neovent)

50 micrograms twice daily


Indacaterol (Onbrez Breezhaler)

150 micrograms 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 MIMS December 2012.

d Costs taken from Drug Tariff December 2012.