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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 Chapter
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/

Chapter Links...
 Details...
03.01.01.01  Expand sub section  Selective Beta2 agonists
03.01.01.01  Expand sub section  Short-acting beta2 agonists
Salbutamol
(Ventolin ,Easyhaler,Salamol Easi-Breathe)
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First Choice
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  • Ventolin Evohaler® is first line pMDI short-acting betaagonist
  • Salbutamol Easyhaler® is the first line DPI short-acting betaagonist
  • Aerosol inhalation MDI 100 micrograms/dose
  • Dry powder for inhalation MDI 100 micrograms/dose
  • Ventolin Accuhaler® and Salamol Easi-Breathe® existing patients only. 

   

 
Salbutamol IV
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Formulary
traffic lightRed
  • Injection 500 micrograms/1ml
  • Solution for IV infusion 5mg in 5ml   
 
 
Salbutamol Nebuliser Solution
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Formulary
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  • Acute use in hospital / GP surgeries or short term use at home.
  • Long term use is generally ineffective and should be used only under specialist guidance. 
  • Salbutamol nebuliser solution 2.5mg in 2.5ml, 5mg in 2.5ml
 
 
Terbutaline
(Bricanyl Turbohaler)
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Formulary
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  • Turbohaler dry powder inhaler MDI 500 micrograms/dose
 
 
Terbutaline IV
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Formulary
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  • Injection 500 micrograms/ml, 2.5mg/5ml
 
 
Terbutaline Nebuliser Solution
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Formulary
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  • Consider if intolerant of salbutamol or uses terbutaline turbohaler. 
  • Respules 2.5mg/ml

 

 
 
03.01.01.01  Expand sub section  Long-acting beta2 agonists
 note 

Current COPD and Asthma guidance is not in favour of using LABA on its own. 

LABAs should be taken only in combination with a corticosteroid to treat asthma.

In COPD LABAs should be offered in a combination with LAMA if there are no

asthmatic features/features suggesting steroid responsiveness or considered in combination with ICS if there are asthmatic features/features

suggesting steroid responsiveness. 

For people using long-acting bronchodilators outside of above recommendations

before NICE guideline [NG115] was published (December 2018), explain to them

that they can continue with their current treatment until both they and their NHS healthcare professional agree it is appropriate to change. 

Salmeterol (Serevent)
(pMDI and DPI)
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Formulary
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  • No new prescribing. Existing patients only - see notes above.
  • Aerosol inhalation MDI 25 micrograms/dose (generic)
  • Licensed 4 years +
  • Serevent® Evohaler Aerosol inhalation MDI 25 micrograms/dose
  • Serevent® Accuhaler Dry powder for inhalation 50 micrograms/dose
 
 
Formoterol
(Oxis Turbohaler)
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Formulary
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  • No new prescribing. Existing patients only - see notes above.
  • Oxis®Turbohaler dry powder inhaler MDI 6 micrograms/dose,12 micrograms/dose
  • Licensed 6 years +
  • Note: Formoterol - licensed for use when adequate treatment with corticosteroids is not sufficient.
  • Salmeterol 50 micrograms is roughly equivalent to Formoterol 9 micrograms.

 

 
 
Indacaterol
(Onbrez Breezhaler)
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Formulary
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  • No new prescribing. Existing patients only - see notes above.
  • Inhalation powder, hard capsule 150, 300 micrograms (via Onbrez Breezhaler® device)

 

 

 
 
Olodaterol
(Striverdi Respimat)
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Formulary
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  • No new prescribing. Existing patients only - see notes above.
  • The delivered dose is 2.5 microgram Olodaterol (as hydrochloride) per actuation.

 

 
 
 ....
 Non Formulary Items
Bambuterol (Bambec)

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Non Formulary
 
Fenoterol

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Non Formulary
 
Formoterol Fumarate
(Atimos Modulite)

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Non Formulary
 
Formoterol Fumarate
(Foradil®)

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Non Formulary
 
Salbutamol
(Asmasal Clickhaler®)

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Non Formulary
 
Salbutamol
(Salamol®Easi-Breathe)

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Non Formulary
 
Salbutamol
(Ventmax® SR)

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Non Formulary
 
Salbutamol
(Ventolin®)

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Non Formulary
 
Salbutamol (Volmax®)

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Non Formulary
 
  
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
click to search medicines.org.uk
Link to adult BNF
click to search medicines.org.uk
Link to SPCs
SMC
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG
Blueteq
High Cost Drug Approval System

Traffic Light Status Information

Status Description

Traffic LightRed

RED - Hospital only to be prescribed by a specialist and supplied from secondary care ONLY throughout treatment.  

Traffic LightAmber

Amber medicines are considered suitable for GP prescribing following specialist initiation or recommendation.  

Traffic LightAmber with Shared Care

Shared Care - these medicines require specialist initiation and stabilisation. Ongoing division of responsibility for drug and disease monitoring between specialist and GP by a Shared Care Guideline (SCG). If no SCG in place status reverts to red.  

Traffic LightGreen

These medicines are appropriate for initiation in both primary and secondary care. Prescribing is appropriate within licensed or local recommendations.  

Traffic LightSelf

Suitable for patient to be directed to buy themselves  

Traffic LightGrey

Not currently used. We intend to include this TLS in future to highlight where a decision to use this medicine is under review.   

Traffic LightBlack

(In use from Oct 2020) Used where a decision has been made by the BSW APC not to routinely commission this preparation for its licensed indications. Do not prescribe.   

Traffic LightRed Specialist Centre

Not currently used. We intend to include this TLS in future to highlight where this medicine and indication is ONLY available through a Specialist Centre according to a NICE Highly Specialised Technology or NHSE Specialised Commission Circular / Policy.  

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