Traffic Lights - Latest Updates

The LLR COPD guidelines have been updated (June 2026) and LAMAs are no longer routinely recommended as a treatment option. No NEW initiations. For patients established on this therapy, treatment should be reviewed on a case-by-case basis, taking into account clinical stability and patient preference. Ongoing prescribing should be in line with the updated COPD guidelines.

1st Choice Dry Powder

COPD: In line with LLR COPD guidelines

Asthma: Not licensed.

Can be used in people with renal impairment with no concern.

In use shelf-life: 2 months

For preventing migraine in adults who have at least 4 migraine days per month and if at least 3 different classes of preventative medicines have not worked, or are not tolerated, or are unsuitable due to safety concerns. See NICE TA973 for full details.

To be prescribed in line with the LLR Migraine pathway

2nd Choice Dry Powder

Asthma – Adult Guidelines

LLR Adult Asthma Guideline (≥18 years) AIR and MART FAQ

The LLR asthma guidelines have been updated (May 2024). Fostair pMDI is no longer recommended as an option. Please review all patients to see if they can be changed to a formulary choice dry powder inhaler device in the first instance. Where an MDI device is required please review to Luforbec in line with guidance.

The LLR COPD guidelines have been updated (June 2026) and ICS/LABA combinations are no longer routinely recommended as a treatment option. No NEW initiations. For patients established on this therapy, treatment should be reviewed on a case-by-case basis, taking into account clinical stability and patient preference. Ongoing prescribing should be in line with the updated COPD guidelines.

1st choice aerosol

Management of Asthma in Adults

LLR Adult Asthma Guideline (≥18 years) AIR and MART FAQ

The LLR COPD guidelines have been updated (June 2026) and ICS/LABA combinations are no longer routinely recommended as a treatment option. No NEW initiations. For patients established on this therapy, treatment should be reviewed on a case-by-case basis, taking into account clinical stability and patient preference. Ongoing prescribing should be in line with the updated COPD guidelines.

Antimicrobial Guide – Acne Vulgaris

Antimicrobial Guide – Acne Vulgaris

For adults 18 years and over. No new initiations. Continued prescribing for established, well controlled patients only.

Must be used regularly for maximum benefit; twice a day dosing. The 160/4.5 strength is licensed to be prescribed as maintenance and reliever therapy (MART).

LLR Adult Asthma Guideline (≥18 years) AIR and MART FAQ

The LLR COPD guidelines have been updated (June 2026) and ICS/LABA combinations are no longer routinely recommended as a treatment option. No NEW initiations. For patients established on this therapy, treatment should be reviewed on a case-by-case basis, taking into account clinical stability and patient preference. Ongoing prescribing should be in line with the updated COPD guidelines.

Budesonide rectal foam. To be used as an alternative to prednisolone enemas. Please note, predisolone enemas are currently significantly more expensive than budesonide

Asthma – Adult Guidelines

Management of Asthma in Children and Young People aged 12-17 years

Management of Asthma in Children aged 5-11 years

LLR Adult Asthma Guideline (≥18 years) AIR and MART FAQ

3rd Choice Dry Powder

Management of Asthma in Adults

Management of Asthma in Children aged 5-11 years

Management of Asthma in Children and Young People aged 12-17 years

LLR Adult Asthma Guideline (≥18 years) AIR and MART FAQ

The LLR COPD guidelines have been updated (June 2026) and ICS/LABA combinations are no longer routinely recommended as a treatment option. No NEW initiations. For patients established on this therapy, treatment should be reviewed on a case-by-case basis, taking into account clinical stability and patient preference. Ongoing prescribing should be in line with the updated COPD guidelines.

As per recommendations in LLR antimicrobial guidelines.

Particular formulation listed stocked in Omcare service in primary care for when prescribed by PTCDA and virtual ward teams

COPD: The LLR COPD guidelines have been updated (June 2026) and LABAs are no longer routinely recommended as a treatment option. No NEW initiations. For patients established on this therapy, treatment should be reviewed on a case-by-case basis, taking into account clinical stability and patient preference. Ongoing prescribing should be in line with the updated COPD guidelines.

Asthma: formoterol should only be prescribed as part of a combination device (ICS/LABA), and a formoterol single agent inhaler should only be used in the few patients who require ciclesonide MDI as an ICS (licence > 12 years)

In use shelf-life: 3 months

1st Choice Dry Powder

COPD: The LLR COPD guidelines have been updated (June 2026) and LABAs are no longer routinely recommended as a treatment option. No NEW initiations. For patients established on this therapy, treatment should be reviewed on a case-by-case basis, taking into account clinical stability and patient preference. Ongoing prescribing should be in line with the updated COPD guidelines.

Asthma: formoterol should only be prescribed as part of a combination device (ICS/LABA), and a formoterol single agent inhaler should only be used in the few patients who require ciclesonide MDI as an ICS (licence > 6 years).

In use shelf-life: 4 months

2nd Choice Dry Powder

COPD: The LLR COPD guidelines have been updated (June 2026) and LABAs are no longer routinely recommended as a treatment option. No NEW initiations. For patients established on this therapy, treatment should be reviewed on a case-by-case basis, taking into account clinical stability and patient preference. Ongoing prescribing should be in line with the updated COPD guidelines.

Asthma: formoterol should only be prescribed as part of a combination device (ICS/LABA), and a formoterol single agent inhaler should only be used in the few patients who require ciclesonide MDI as an ICS (licence > 6 years).

In use shelf-life: manufacturer’s expiry date

2^nd Choice Aerosol

COPD: (87/5/9 only) In line with LLR COPD guidelines

Asthma: Not recommended in LLR

In use shelf-life: 4 months

Existing patients to remain on this. No active switching to Trixeo.

1st Choice Dry Powder

COPD: In line with LLR COPD guidelines

Asthma: Not licensed.

In use shelf-life: 6 weeks

The LLR COPD guidelines have been updated (June 2026) and SAMAs are no longer routinely recommended as a treatment option. No NEW initiations. For patients established on this therapy, treatment should be reviewed on a case-by-case basis, taking into account clinical stability and patient preference. Ongoing prescribing should be in line with the updated COPD guidelines.

Please note, significantly more expensive than budesonide suppositories. Should be used by, or on advice from GI specialist only

For preventing episodic migraine in adults who have at least 4 and fewer than 15 migraine attacks per month, only if at least 3 preventative treatments have not worked in line with NICE TA906.

To be prescribed in line with the LLR Migraine pathway

The LLR COPD guidelines have been updated (June 2026) and LAMAs are no longer routinely recommended as a treatment option. No NEW initiations. For patients established on this therapy, treatment should be reviewed on a case-by-case basis, taking into account clinical stability and patient preference. Ongoing prescribing should be in line with the updated COPD guidelines.

The LLR COPD guidelines have been updated (June 2026) and LAMAs are no longer routinely recommended as a treatment option. No NEW initiations. For patients established on this therapy, treatment should be reviewed on a case-by-case basis, taking into account clinical stability and patient preference. Ongoing prescribing should be in line with the updated COPD guidelines.

1st Choice Aerosol

COPD: In line with LLR COPD guidelines

Asthma: Not licensed.

Tiotropium should only be used if the expected benefit outweighs the risk in people with moderate to severe renal impairment (CrCl ≤ 50 ml/min).

In use shelf-life cartridge: 3 months

In use shelf-life inhaler device: 1 year (max 6 cartridges)

Currently, there is no commissioned service within general practice to support this prescribing. This position is under review. Consequently, GPs are not obligated to issue these prescriptions.