Formulary


	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 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...

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

03.01.01.01

Short-acting beta₂ agonists

03.01.01.01

Long-acting beta₂ agonists

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)

Formulary

traffic light

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^®)

Formulary

traffic light

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^®)

Formulary

traffic light

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

Olodaterol
(Striverdi Respimat^®)

Formulary

traffic light

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

....

Key

	Notes
	Section Title (top level)
	Section Title (sub level)
	First Choice item
	Non Formulary section
	Restricted Drug
	Unlicensed
	Display tracking information
	Link to adult BNF
	Link to SPCs
	Scottish Medicines Consortium

	Cytotoxic Drug
	Controlled Drug
	High Cost Medicine
	Cancer Drugs Fund
	NHS England
	Homecare
	CCG
	High Cost Drug Approval System

Traffic Light Status Information

Status	Description
	RED - Hospital only – to be prescribed by a specialist and supplied from secondary care ONLY throughout treatment.
	Amber medicines are considered suitable for GP prescribing following specialist initiation or recommendation.
	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.
	These medicines are appropriate for initiation in both primary and secondary care. Prescribing is appropriate within licensed or local recommendations.
	Suitable for patient to be directed to buy themselves
	Not currently used. We intend to include this TLS in future to highlight where a decision to use this medicine is under review.
	(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.
	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.