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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...
03.01.03  Expand sub section  Theophylline
 note 

Theophylline products are not interchangeable and should be prescribed by BRAND NAME.

Remember narrow therapeutic window and potential for interactions.

The half-life is increased (giving higher theophylline levels) in heart failure,cirrhosis

and viral infections, in the elderly and by drugs as cimetidine,ciprofloxacin,

erythromycin, fluvoxamine, diltiazem, verapamil and oral contraceptives. Vomiting

may indicate a toxic dose.

The half-life is decreased (giving lower theophylline levels) in smokers, in

chronic alcoholism and by drugs as phenytoin, carbamazepine, rifampicine

and barbiturates.

To avoid excessive dosage in obese patients , dose should be calculated in

the basis of ideal body weight. 

Plasma-theophylline concentration should be available to guide dosing of

iv aminophylline in patients taking oral theophylline or aminophylline. 

Aminophylline (Phyllocontin Continus)
View adult BNF View SPC online
Formulary
Green
  • Modified release tablets 225mg (Phyllocontin®) m/r
  • In asthma - use only at Step 4, after long acting β2 agonists,leukotriene antagonist and high dose steroids.  Referral may be preferable. 
  • In COPD - Not recommended for routine use. Referral may be preferable.
 
   
Aminophylline IV 
View adult BNF View SPC online
Formulary
Red
  • Aminophylline Injection 250 mg/10ml
  • For selected patients with acute severe asthma or severe exacerbations of COPD.
 
   
Theophylline (Uniphyllin Continus)
View adult BNF View SPC online
Formulary
Green
  • Modified release tablets 200mg, 300mg, 400mg
  • In asthma - use only at Step 4, after long acting β2 agonists,leukotriene antagonist and high dose steroids.  Referral may be preferable. 
  • In COPD - Not recommended for routine use. Referral may be preferable.
 
   
 ....
 Non Formulary Items
Theophylline (Slo-Phyllin)

View adult BNF View SPC online
Non Formulary

Removed from formulary Nov 2019 as Manufacture of Slo-phyllin

(Theophylline) 60mg/125mg/500mg capsules has ceased.

See here for MHRA Supply Disruption Alert for advice on the management of patients currently using this medicine.

 
  
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

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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