The July 2019 update to the NICE guideline NG115 focused on promoting responsible prescribing of triple inhaled therapies to ensure people get the most benefit from them while limiting adverse effects and doing so in the most cost- effective way. The update does not comment on the appropriateness or perceived benefit of using all three medicines in one single inhaler device as opposed to separate inhalers, as this was outside of its scope. However, people are more likely to use their inhalers if the number and types of device an individual has to use is minimised.

Before an individual starts LAMA+LABA+ICS therapy, healthcare professionals should conduct a clinical review to ensure that:

• Their non-pharmacological COPD management is optimised, and they have used or been offered treatment for tobacco dependence if they smoke
• Acute episodes of worsening symptoms are caused by COPD exacerbations and not by another physical or mental health condition
• Their day-to-day symptoms that are adversely impacting their quality of life are caused by COPD and not by another physical or mental health condition.

NICE also recommends documenting the reason for continuing ICS use in clinical records and reviewing this at least once a year.

NICE has produced a visual summary covering non- pharmacological management of COPD and use of inhaled therapies.

Once you've completed this module, move onto:
Part four: Side effects of COPD treatment and reducing risks
But be sure to click next to complete this module first.