Adapting Inhaled Medication Practice in COPD and Asthma to Avoid Funding the Tobacco Industry

Figures & data

Table 1 Current Approved Inhaled Medicines Associated with Vectura

Product	Manufacturer(s)/Partners
Flutiform pMDI	Kyorin (Japan)
	MundiPharma
Flutiform K-haler	MundiPharma
Ultibro Breezhaler	Novartis
Seebri Breezhaler	Novartis
Enerzair Breezhaler	Novartis
AirFluSal Forspiro	Sandoz
AirBuFo Forspiro^‡	Sandoz
Fluticasone Propionate and Salmeterol*	Hikma (US)
Breelib^†	Bayer
Incruse Ellipta	GSK
Anoro Ellipta	GSK
Relvar/Breo Ellipta	GSK
Trelegy Ellipta	GSK

Notes: Information adapted from Vectura accounts.¹⁰ *Hikma Pharmaceuticals plc announced that they had resumed the launch of a generic version of Advair diskus in the US.²³ †Breelib is a nebuliser approved for the administration of iloprost (Ventavis^®) and generic Iloprost Zentiva nebuliser solution to adult patients with primary pulmonary hypertension. ^‡AirBuFo Forspiro is authorised in a number of Member States of the EEA, including Belgium, Denmark, France, Ireland, Italy, Norway, Portugal, Spain, Sweden²⁴.

Figure 1 Inhaler devices listed in the Vectura accounts as generating revenue, or income from “royalty & other marketed revenues”. https://www.vectura.com/wp-content/uploads/2021/04/Vectura-Group-plc-Annual-Report-and-Accounts-2020.pdf– clockwise from top left: Novartis Breezhalers, Mundipharma Flutiform k-haler, Sandoz AirFluSal Forspiro, GSK Ellipta inhalers.

Table 2 Potential Alternatives to Inhalers for COPD and Asthma That are Not Associated with Vectura

Brand Name	Generic Drugs	Licence	Manufacturer/Partners	Alternative Options
Flutiform pMDI	Fluticasone Propionate/Formoterol	Asthma	Kyorin	No alternatives in same drug combination. Alternatives in pMDI include • beclometasone/formoterol (Fostair^®, Luforbec^®) • Fluticasone Propionate/salmeterol (AirFluSal^®, Aloflute^®, Combisal^®, Sereflo^®, Seretide^®, Sirdupla^®) - NB. Not all brands available in low, medium and high dose ICS. • Budesonide/formoterol (Symbicort^®). NB. Only available in two strengths (low and medium dose), and with HFA 227 propellant with a very high carbon impact.
			MundiPharma
Flutiform K-haler	Fluticasone Propionate/Formoterol	Asthma	MundiPharma	Flutiform K-haler discontinued in UK April 2021. No ICS/LABA available in breath-actuated pMDI devices. For alternatives in pMDI, see Flutiform pMDI, above.
Ultibro Breezhaler	Indacaterol/glycopyrronium	COPD	Novartis	DPI alternative: • Duaklir Genuair (formoterol/aclidinium) Aerosol alternatives: • Bevespi Aerosphere pMDI (formoterol/glycopyrronium) • Spiolto Respimat (olodaterol/tiotropium)
Seebri Breezhaler	Glycopyrronium	COPD	Novartis	DPI alternative: • Eklira Genuair (aclidinium) • Tiotropium (Spiriva^® HandiHaler, Braltus^® Zonda, Tiogiva^® MRX003-R inhaler, Acopair^® NeumoHaler) Aerosol alternative: • Spiriva Respimat (tiotropium)
Enerzair Breezhaler	Mometasone/Indacaterol/glycopyrronium	Asthma	Novartis	There are no alternative ICS/LABA/LAMA DPI inhalers licensed for use in asthma. DPI alternatives would require use of a suitable ICS/LABA DPI in combination with Spiriva Respimat (the only licensed LAMA for asthma). Aerosol alternative: • Trimbow MDI (budesonide/formoterol/glycopyrronium). NB. Trimbow is licensed in asthma as a medium dose ICS, whilst Enerzair is a high dose ICS, so a switch would represent an ICS dose reduction.
AirFluSal Forspiro	Fluticasone Propionate/Salmeterol	Asthma, COPD	Sandoz	Alternative DPIs include: • Fluticasone Propionate/Salmeterol DPIs: Seretide^® Accuhaler, Fixkoh^® Airmaster, Fusacomb^® Easyhaler, Stalpex^® G7 inhaler Alternative DPIs for other ICS/LABA drugs include: • Budesonide/formoterol: DuoResp^® Spiromax, Fobumix^® Easyhaler, Symbicort^® Turbohaler Beclometasone/formoterol: (Fostair^® NEXThaler)
AirBuFo Forspiro	Budesonide/formoterol	Asthma, COPD	Sandoz	Not licensed in the UK. Alternative DPIs include: • Budesonide/formoterol: DuoResp^® Spiromax, Fobumix^® Easyhaler, Symbicort^® Turbohaler Alternative DPIs for other ICS/LABA drugs include: • Beclometasone/formoterol: (Fostair^® NEXThaler) Fluticasone Propionate/Salmeterol DPIs: Seretide^® Accuhaler, Fixkoh^® Airmaster, Fusacomb^® Easyhaler, Stalpex^® G7 inhaler
Fluticasone Propionate and Salmeterol*	Fluticasone Propionate/Salmeterol	Asthma, COPD	Hikma	Not licensed in the UK. Alternative DPIs include: Fluticasone Propionate/Salmeterol DPIs: Seretide^® Accuhaler, Fixkoh^® Airmaster, Fusacomb^® Easyhaler, Stalpex^® G7 inhaler
Breelib†	Nebuliser for administration of Ventavis (iloprost), or generic Iloprost Zentiva	Pulmonary Hypertension	Bayer	No other licensed iloprost nebuliser solution preparations available
Incruse Ellipta	Umeclidinium	COPD	GSK	DPI alternative: • Eklira Genuair (aclidinium) • Tiotropium (Spiriva^® HandiHaler, Braltus^® Zonda, Tiogiva^® MRX003-R inhaler, Acopair^® NeumoHaler) Aerosol alternative: • Spiriva Respimat (tiotropium)
Anoro Ellipta	Vilanterol/Umeclidinium	COPD	GSK	DPI alternative: • Duaklir Genuair (formoterol/aclidinium) Aerosol alternatives: • Bevespi Aerosphere pMDI (formoterol/glycopyrronium) • Spiolto Respimat (olodaterol/tiotropium)
Relvar/Breo Ellipta	Fluticasone furoate/vilanterol	Asthma, COPD	GSK	No alternatives in same drug combination. DPI alternatives: • Fluticasone Propionate/Salmeterol DPIs: Seretide^® Accuhaler, Fixkoh^® Airmaster, Fusacomb^® Easyhaler, Stalpex^® G7 inhaler • Budesonide/formoterol: DuoResp^® Spiromax, Fobumix^® Easyhaler, Symbicort^® Turbohaler • Beclometasone/formoterol: (Fostair^® NEXThaler)
Trelegy Ellipta	Fluticasone furoate/vilanterol/glycopyrronium	COPD	GSK	DPI alternative: • Trimbow NEXThaler (budesonide/formoterol/glycopyrronium). Available from September 2021. Aerosol alternatives: • Trimbow MDI (budesonide/formoterol/glycopyrronium).

Notes: The table is illustrative, and the alternatives suggested are based on UK prescribing. Given local availability and licensing the range of options may be different in other countries.

Vectura. Vectura Group plc annual report and accounts 2020; 2021. Available from: https://www.vectura.com/wp-content/uploads/2021/04/Vectura-Group-plc-Annual-Report-and-Accounts-2020.pdf. Accessed August 20, 2021.

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Vectura. Vectura highlights update made by Hikma on launch of generic Advair Diskus®; 2021. Available from: https://ir.q4europe.com/Solutions/VecturaIntranet/3832/newsArticle.aspx?storyid=15036321. Accessed October 15, 2021.

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Rowex. Package leaflet: AirBuFo® Forspiro® 160 microgram/4.5 microgram/dose inhalation powder, pre-dispensed. last revision; 2018. Available from: https://www.hpra.ie/img/uploaded/swedocuments/2208694.PA0711_284_001.418b6375-936e-4333-b543-e4c22f605a13.000001AirBuFo%20PIL.180731.pdf. Accessed October 15, 2021.

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