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...

03.01.03

Theophylline

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 IV

Formulary

traffic light

Aminophylline Injection 250 mg/10ml
For selected patients with acute severe asthma or severe exacerbations of COPD.

Theophylline
(Uniphyllin^® Continus)

Formulary

traffic light

Modified release tablets 200mg, 300mg, 400mg
For patients switching to theophylline from aminophylline - Advice and information in the DHSC SDA/2021/003 here should be used to support local decision making and guide dose conversions.

....

Non Formulary Items

Aminophylline
(Phyllocontin Continus^®)

Non Formulary

Removed from formulary Feb 2021 as Manufacture of Phyllocontin® (Aminophylline) 225mg and 350mg MR tablets are being discontinued in the UK with supplies expected to be exhausted by April 2021.

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

Theophylline
(Slo-Phyllin^®)

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

	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.