| Formulary Chapter 3: Respiratory system - Full Chapter
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| Notes: |
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/
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| Chapter Links... |
 NICE CG101: COPD guideline |
| NICE TA10: Asthma inhaler devices (children under 5) |
| NICE TA38: Asthma inhaler devices (older children) |
| Details... |
| 03.01.01.01 |
Selective Beta2 agonists |
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Short-acting beta2 agonists |
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Salbutamol
(Ventolin ®,Easyhaler®,Salamol Easi-Breathe®)
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First Choice
 
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- Ventolin Accuhaler® and Salamol Easi-Breathe® existing patients only.
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Salbutamol IV
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Formulary
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- Injection 500 micrograms/1ml
- Solution for IV infusion 5mg in 5ml
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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
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Terbutaline
(Bricanyl Turbohaler®)
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Formulary
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- Turbohaler dry powder inhaler MDI 500 micrograms/dose
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Terbutaline IV
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Formulary
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- Injection 500 micrograms/ml, 2.5mg/5ml
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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
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| 03.01.01.01 |
Long-acting beta2 agonists |
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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. |
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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
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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.
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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)
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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.
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| Non Formulary Items |
Bambuterol
(Bambec®)
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Non Formulary
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Fenoterol
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Non Formulary
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Formoterol Fumarate
(Atimos® Modulite)
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Non Formulary
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Formoterol Fumarate
(Foradil®)
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Non Formulary
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Salbutamol
(Asmasal Clickhaler®)
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Non Formulary
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Salbutamol
(Salamol®Easi-Breathe)
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Non Formulary
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Salbutamol
(Ventmax® SR)
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Non Formulary
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Salbutamol
(Ventolin®)
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Non Formulary
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Salbutamol
(Volmax®)
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Non Formulary
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Key |
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Cytotoxic Drug
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Controlled Drug
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High Cost Medicine
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Cancer Drugs Fund
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NHS England |
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Homecare |
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CCG |
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High Cost Drug Approval System |
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Traffic Light Status Information
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