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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...
03.01.02  Expand sub section  Antimuscarinic bronchodilators
Tiotropium  (Braltus Zonda)
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First Choice
Green
  • First-line long-acting muscarinic receptor antagonist for COPD ONLY
  • See MHRA Drug Safety Update May 18 for information on the risk ofcapsule inhalation if capsule placed in mouthpiece.
  •  Braltus 10 micrograms delivered dose inhalation powder hard capsule(Zonda Inhaler device). Each capsule contains 16 micrograms oftiotropium bromide equivalent to 13 micrograms of tiotropium.

 

 

 
Tiotropium (Spiriva Respimat)
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First Choice
Green
  • First-line long-acting muscarinic receptor antagonist for COPD
  • Respimat® (solution for inhalation) 2.5 micrograms/metered inhalation.
  • This is the ONLY LAMA licensed for asthma.

 

 
Aclidinium (Eklira Genuair)
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Second Choice
Green
  • For patients with manual dexterity problems or an eGFR<30ml/min. 
  • Inhalation powder 322 microgram/dose aclidinium

 

 

 

 
   
Glycopyrronium (Seebri breezhaler)
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Second Choice
Green
  • Each capsule contains 63 micrograms of glycopyrronium bromide equivalent to 50 micrograms of glycopyrronium.
  • Each delivered dose (the dose that leaves the mouthpiece of the inhaler) contains 55 micrograms of glycopyrronium bromide equivalent to 44 micrograms of glycopyrronium.

 

 
   
Umeclidinium (Incruse Ellipta)
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Third Choice
Green
  • Monotherapy for existing patients ONLY. For patients who can'tmanage the inhaler devices available as first or second line options. 
  • DO NOT use as part of triple therapy with Relvar. Where tripletherapy is needed please prescribe Trelegy if patient prefers the Ellipta device. 
  • Inhalation powder 55microgram / dose umeclidinium equivalent to 65 micrograms of umeclidinium bromide.

 

 

 

 
   
Ipratropium Bromide
(Atrovent)
(Short-acting (SAMA))
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Formulary
Green
  •  Inhaler 20 micrograms/dose

 

 
   
Ipratropium Bromide Nebuliser Solution
(Ipratropium Steri-Neb)
View adult BNF View SPC online
Formulary
Green

 

  • Nebuliser solution 250 micrograms in 1 ml, 500micrograms in 2ml

 

 
   
 ....
 Non Formulary Items
Ipratropium 

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Non Formulary
 
Ipratropium Bromide
(Respontin)

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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
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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

Red

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

Amber

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

Amber 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.  

Green

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

Self

Suitable for patient to be directed to buy themselves  

Grey

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

Black

Not currently used. We intend to include this TLS in future to highlight where a decision has been made by either or both the local or national NHS not to routinely commission this preparation for its licensed indications. Do not prescribe.  

Red 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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