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NHS Bath and North East Somerset, Swindon and Wiltshire CCG
Royal United Hospitals Bath NHS Foundation Trust
Great Western Hospitals NHS Foundation Trust
Salisbury NHS Foundation Trust
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 Formulary Chapter 3: Respiratory system - Full Section
Notes:

Respiratory-related Prescribing Guidance

Please see our Prescribing Guidelines page for all prescribing guidance relating to this chapter.

Respiratory-related Shared Care Agreements

Please see our Shared Care Agreements page for all shared care agreements (SCAs) relating to this chapter.

National guidance - The Respiratory Chapter should be read in conjunction with BTS guidelines , BTS/SIGN Asthma Guidelines  and NICE guidelines on COPD and Asthma

Guidance on inhaler devices 

Inhalers should always be prescribed by their BRAND name. 

The patient's ability to use a device should be assessed by a competent healthcare professional and re-assessed as part of structured clinical review. If the patient is unable to use a device satisfactorily, an alternative should be found.

RightBreathe is a free app/website designed to help clinicians and patients use inhaled therapy and devices appropriately https://www.rightbreathe.com/. Asthma.org has patient-friendly videos of inhaler technique here.

In children aged 0-5 years, pMDI and spacer are the preferred delivery method for β2 agonists or inhaled steroids. A face mask is required until the child can breathe reproducibly using the spacer mouthpiece. 

Self-care

Many of the products in this chapter are available for purchase over-the-counter, and patients are encouraged to self-care, with the support of their community pharmacist, in the first instance. For further information on self-care & the NHS, please refer to https://www.england.nhs.uk/medicines/conditions-for-which-over-the-counter-items-should-not-routinely-be-prescribed/

 Useful Links
Numbers in brackets indicate counts of (Formulary items, Non Formulary items)
03.01 Bronchodilators (0,0)
03.01.01 Adrenoceptor agonists (0,0)
03.01.01.01 Selective Beta2 agonists (0,9)
Short-acting beta2 agonists (6,0)
Long-acting beta2 agonists (4,0)
03.01.01.02 Other adrenoceptor agonists (0,2)
03.01.02 Antimuscarinic bronchodilators (7,2)
03.01.03 Theophylline (3,1)
03.01.04 Compound bronchodilator preparations (5,1)
03.01.05 Peak flow meters, inhaler devices and nebulisers (0,0)
Peak flow meters (1,0)
Drug delivery devices (2,0)
Nebuliser Diluent (1,0)
03.02 Corticosteroids (6,5)
03.02.02 Compound Corticosteroid/ Long acting beta-agonist inhalers (8,0)
Triple Therapy products for COPD (2,0)
03.03 Cromoglicate, related therapy and leukotriene receptor antagonists (0,0)
03.03.01 Cromoglicate and related therapy (0,4)
03.03.02 Leukotriene receptor antagonists (1,1)
03.03.03 Phosphodiesterase type-4 inhibitors (1,0)
03.04 Antihistamines, hyposensitisation, and allergic emergencies (0,0)
03.04.01 Antihistamines (0,0)
Non-sedating antihistamines (3,6)
Sedating antihistamines (3,5)
03.04.02 Allergen Immunotherapy (0,6)
Omalizumab (1,0)
03.04.03 Allergic emergencies (0,0)
Anaphylaxis (4,0)
Angioedema (2,1)
03.05 Respiratory stimulants and pulmonary surfactants (0,0)
03.05.01 Respiratory stimulants (1,0)
03.05.02 Pulmonary surfactants (1,1)
03.06 Oxygen (0,0)
03.07 Mucolytics (2,2)
Dornase alfa (1,0)
Hypertonic Sodium Chloride (1,0)
Mannitol (2,0)
03.08 Aromatic inhalations (1,1)
03.09 Cough preparations (0,0)
03.09.01 Cough suppressants (1,6)
03.09.02 Expectorant and demulcent cough preparations (1,2)
03.10 Systemic nasal decongestants (0,2)
03.11 Antifibrotics (1,2)
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