Respiratory prescribing is long term and can be costly. Appropriate choice and use of inhaled therapy is key to the successful management of COPD. In COPD, there is a need to review use of inhaled steroids as their use when FEV1 is above 50% is not recommended and can lead to increased risk of pneumonia and other respiratory infections.1 This audit will highlight patients currently prescribed an inhaled corticosteroid for the treatment of COPD and will make recommendations where appropriate in order to stop or change to the most cost effective, formulary option. D&G formulary recommends either Duoresp Spiromax® (a dry powder inhaler DPI) or Fostair® MDI as first line choice in patients, over 18 years of age, with COPD. Duoresp Spiromax® has been shown to have comparable quality and be bioequivalent to the same strengths of Symbicort® turbohaler. It is also expected to have the same benefits as Symbicort® in improving lung function and relieving symptoms in COPD.