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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...
03.01.04  Expand sub section  Compound bronchodilator preparations
 note 

 

Compound broncodilator preparations are considered to have no place in the management of patients with asthma.

NICE COPD guideline NG115 recommends: 

Offer LAMA+LABA[2] to people who:

  • have spirometrically confirmed COPD and

  • do not have asthmatic features/features suggesting steroid responsiveness and

  • remain breathless or have exacerbations despite:

     

    • having used or been offered treatment for tobacco dependence if they smoke and

    • optimised non-pharmacological management and relevant vaccinations and

    • using a short-acting bronchodilator. [2018]

Aclidinium and formoterol inhaler
(Duaklir Genuair )
(LABA/LAMA)
View adult BNF View SPC online
Formulary
Green
  • Combination of Formoterol fumarate / Aclidinium (as bromide)
  • Breath actuated dry powder MDI 12/340 Genuair device

 

 
   
Glycopyrrolate/ indacaterol inhaler
(Ultibro Breezhaler)
(LABA/LAMA)
View adult BNF View SPC online
Formulary
Green
  • Combination of Indacaterol / Glycopyrronium
  • Breezehaler device with inhalation powder hard capsules each capsule contains equivalent of 110 micrograms of indacaterol and 50 micrograms of glycopyrronium

 

 

 
   
Tiotropium & olodaterol
(Spiolto Respimat)
(LABA/LAMA)
View adult BNF View SPC online
Formulary
Green
  • Combination of Tiotropium (bromide monohydrate) / Olodaterol (hydrochloride)
  • Respimat device tiotropium 2.5micrograms / olodaterol 2.5micrograms per inhalation

 

 

 
   
Umeclidinium & vilanterol
(Anoro Ellipta)
(LABA/LAMA)
View adult BNF View SPC online
Formulary
Green
  • Combination of Vilanterol (as trifenatate) / Umeclidinium bromide
  • Ellipta device vilanterol 22micrograms / umeclidinium 55micrograms per inhalation

 

 

 

 
   
Ipratropium bromide with salbutamol
(Combivent)
(SABA/SAMA)
View adult BNF View SPC online
Formulary
Green

 

  • Ipratropium bromide 500micrograms & salbutamol sulphate 2.5mg/ 2.5ml Unit Dose Vial  (nebulised)
  • NB - less suitable for prescribing. Licensed for bronchospasm in patients with COPD. BNF states flexibility of dosing is lost with a compound bronchodilator but it may be appropriate for patients stabilised on the individual components in the same proportion.Consider if compliance an issue.

 

 
   
 ....
 Non Formulary Items
Duovent 

View adult BNF View SPC online
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
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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