Proxor or Bibecfo: Best value, preferred inhaled corticosteroid (ICS)/long-acting beta-2 agonist (LABA) combination pMDI inhaler for anti-inflammatory reliever (AIR)/maintenance and reliver therapy (MART) in respiratory conditions.
In line with the Dorset Formulary, NHS Dorset recommends Bibecfo and Proxor brands as the first line Beclometasone + Formoterol (ICS/LABA) pressurised metered dose inhaler (pMDI) prescribed as part of AIR/MART (anti-inflammatory reliver/maintenance and reliever therapy).
NHS Dorset is asking teams to review existing patients on a Fostair pMDI, using the resources provided and where clinically appropriate, switch 80% of patients with asthma to the better value Proxor or Bibecfo brands of Beclometasone + Formoterol pMDI.
Switching is required by the 30th September 2026.
- Proxor and Bibecfo brands are better values products and first line choices in Dorset.
- Switching to Proxor or Bibecfo will help PCN teams care for patients within their NHS England financial envelope and hence release funds to improve unmet needs in prevention.
- Early switching by the 30th September 2026 is required to maximise cumulative in year cost savings
- NICE guideline 245 does not distinguish between the different brands of ICS/LABA pMDI inhalers.
Notify community pharmacy colleagues of the intention to switch to best value ICS/LABA pMDI.
Work with community pharmacy colleagues to ensure sufficient stock of the preferred branded inhalers is available to support the switching programme and minimise disruption to patients, GP and community pharmacy teams.
Run the SystmOne search provided to identify existing patients prescribed a Fostair pMDI:
Dorset SystmOne GPs> PINH 26 27> F2 Fostair pMDI> 2c Work to do: Fostair pMDI RPT (>11 years) switch to Proxor or Bibecfo pMDI
A risk management approach should be taken to any batch-switching arrangement, which includes safeguards which enable patients to have a review, should they have any queries or changes to their condition.
Exclusion criteria:
- Patients < 12 years of age
- Patients for whom a pMDI is not suitable
- Allergy/sensitivity to excipients in the Proxor/Bibecfo products
- Patients who have trialled and failed on a Proxor and Bibecfo device
Special considerations:
- A face-to-face medication review may be considered for patients with poorly controlled asthma, severe asthma, frequent exacerbations or those under secondary respiratory care
- For those patients clinically suitable to switch to a dry powder inhaler please discuss suitable options at the patient's next face-to-face review
Where clinically appropriate, switch patient to Proxor or Bibecfo pMDI.
How to communicate this to patients:
Use the template patient text message and letter in SystmOne to notify patients of the change.
Text message:
"NHS Dorset has asked GP teams to review use of Fostair brand inhaler and switch to Proxor or Bibecfo brands. These brands contain the same medicines in the same quantity as Fostair but are 1st choice in Dorset. Bibecfo, Proxor and Fostair pMDI use the same inhaler technique, you should not experience any change in clinical effect. Please finish your Fostair supply first, then read the label and patient information leaflet before starting this new inhaler. If you have any questions, please ask your Community Pharmacist for a New Medicines Service Review. If you feel that your respiratory condition requires a medical review, please make an appointment to discuss."
Fostair template patient letter
References:
Tracking achievement:
Numerator divided by Denominator from SystmOne searches x 100 for %
