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GOLD and NICE do not encourage ICS/LABA initiation in COPD patients1,2

NICE: for patients with no asthmatic features/features of steroid responsiveness
GOLD & NICE recommend classes of medicines, not individual products

What does this mean for your newly diagnosed patients with COPD? Joanne King, Clinical Lead for Respiratory Services across Frimley, explains.

Initial Maintenance Therapy

GOLD & NICE recommendations for COPD patients limited by symptoms

Adapted visual shows only GOLD group B and NICE guidance for patients with
no asthmatic features or features suggesting steroid responsiveness

GSK adapted visual of GOLD and NICE guidance

Before starting inhaled therapy GOLD and NICE recommend considering non-pharmacological approaches, such as smoking cessation, pulmonary rehabilitation etc. A short-acting bronchodilator is recommended by GOLD and NICE for additional immediate symptom relief, if needed.
Please refer to individual SmPCs before prescribing

LAMA/LABAs are licensed in the UK as maintenance bronchodilator treatments to relieve symptoms in adult COPD patients.
LAMA/LABAs are not licensed in the UK to treat or reduce the risk of exacerbations.

GSK-adapted from © 2025 Global Strategy for the Diagnosis, Management and Prevention of COPD. All rights reserved. Use is by express license from the owner.
GSK-adapted from © NICE 2019. COPD in over 16s: diagnosis and management. Available from www.nice.org.uk/guidance/ng115. All rights reserved. Subject Notice of rights. NICE guidance is prepared for the National Health Service in England. All NICE guidance is subject to regular review and may be updated or withdrawn. NICE accepts no responsibility for the use of its content in this material.

Why is ICS/LABA not encouraged in COPD?

84.5% of patients continue to experience COPD symptom burden, despite treatment with an ICS/LABA for at least 3 months7 (n=464/549). Symptom burden defined as CAT score ≥10. Data from COPD patients in SPRINT, an observational study.7

ICS containing regimens have a negligible therapeutic effect when eosinophils count <100 cells/µL, and are often associated with an increased incidence of pneumonia1,6

LABA/LAMA vs ICS/LABA graph

Why a LAMA/LABA?

In a 12-week, double-blind trial, COPD patients received once-daily Anoro ︎Ellipta (umeclidinium/vilanterol) - a LAMA/LABA (n=332), or twice-daily Seretide Accuhaler 50µg/500µg (fluticasone propionate/salmeterol) - an ICS/LABA (n=337)3

The LAMA/LABA Anoro Ellipta demonstrated 1.9x greater lung function improvement from baseline vs the ICS/LABA Seretide Accuhaler 50µg/500µg on Day 84 (p<0.001).3

166mL vs 87mL LS mean change from baseline in weighted mean FEV1 over 0 – 24 hrs for Anoro Ellipta vs Seretide Accuhaler 50µg/500µg on Day 84 (treatment difference 80mL, 95% CI: 46-113; p<0.001).3

Chart adapted from Singh D et al. 2015.3

In a 12-week, double-blind trial of Anoro Ellipta (n=358) vs Seretide Accuhaler 50μg/500μg (n=358) there were no unexpected safety findings.3-5

The most common AEs occurring in ≥3% of patients in both groups were headache, nasopharyngitis, back pain and dysphonia.3-5 Please consult the SmPC for more information.

Anoro Ellipta and Seretide Accuhaler 50µg/500µg should be used with caution in patients with severe cardiovascular disease and/or heart rhythm abnormalities.4.5

Seretide Accuhaler 50µg/500µg, in line with other ICS-containing medicines shows an increased risk of pneumonia5

Seretide Accuhaler 50µg/500µg should be used with caution in patients with diabetes mellitus, thyrotoxicosis, uncorrected hypokalemia or patient predisposed to low level of serum potassium.5

Anoro Ellipta should be used with caution in patients with convulsive disorders or thyrotoxicosis, and in patients who are unusually responsive to beta2-adrenergic agonists4

Paradoxical Bronchospasm may occur after Seretide or Anoro dosing.4,5

Not all cautions listed here.

Please consult the respective SmPC for more information4,5

Click for Anoro Ellipta (umeclidinium/vilanterol) prescribing information ANORO ELLIPTA is indicated as a maintenance bronchodilator treatment to relieve symptoms in adult patients with chronic obstructive pulmonary disease (COPD)
Click for Seretide Accuhaler 50µg/500µg (salmeterol xinafoate/fluticasone propionate) prescribing information SERETIDE 500 Accuhaler (50 µg salmeterol and 500 µg fluticasone propionate) is indicated for the symptomatic treatment of patients with COPD, with a FEV1 <60% predicted normal (pre-bronchodilator) and a history of repeated exacerbations, who have significant symptoms despite regular bronchodilator therapy.

Anoro Ellipta was developed in collaboration with INNOVIVA

INNOVIVA

Abbreviations:

AE: adverse event; CAT, COPD Assessment Test; COPD, Chronic Obstructive Pulmonary Disease; GOLD, Global Initiative for Chronic Obstructive Lung Disease; ICS, inhaled corticosteroids, LABA, long-acting beta agonist; LAMA, long-acting muscarinic antagonist; LS, least squared; mMRC, Modified Medical Research Council; NICE, National Institute for Health and Care Excellence

References:

  1. GOLD. Global Strategy for the Diagnosis, Management and Prevention of COPD. 2025 Report.
  2. COPD in over 16s: diagnosis and management NICE guideline [NG115]. Last updated: July 2019. Available from: https://www.nice.org.uk/guidance/ngll5.
  3. Singh D et al. BMC pulmonary medicine 2015;15;1-12.
  4. Anoro Ellipta (umeclidinium bromide/vilanterol) Summary of Product Characteristics.
  5. Seretide Accuhaler (fluticasone propionate/salmeterol) Summary of Product Characteristics
  6. Garcia M et al. Am J Resp Crit Care Med 2020;201(9):1078-1085.
  7. Roche N; npj Primary Care Respiratory Medicine; 2020 ;30;1-7.

 Adverse events should be reported. Reporting forms and information can be found at https://yellowcard.mhra.gov.uk/ or search for MHRA Yellowcard in the Google Play or Apple App store. Adverse events should also be reported to GSK on 0800 221 441 or UKSafety@gsk.com.

August 2025 | PM-GB-UCV-WCNT-240008 (V2.0)