| Formulary Chapter 3: Respiratory system - Full Chapter
|
| Notes: |
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... |
| 03.02.02 |
Compound Corticosteroid/ Long acting beta-agonist inhalers |
|
|
Fluticasone furoate & vilanterol
(Relvar Ellipta®)
(DPI)
|
First Choice
 
|
- First choice ICS/LABA DPI for asthma and COPD.
- Use in COPD:
- Combination of fluticasone furoate and vilanterol (92/22)Breath actuated dry powder inhalerApproved for COPD in use with local guidance and in line with NICE FEV1<50%. Once daily administration.
- Use in asthma:
- Combination of fluticasone furoate and vilanterol (92/22, 184/22)Breath actuated dry powder inhaler for uncontrolled asthmatic patients onlyOnce daily administration
|
|
|
Beclometasone and formoterol
(Fostair®)
(pMDI)
|
First Choice
|
|
|
|
Beclometasone and formoterol
(Fostair NEXThaler®)
(DPI)
|
First Choice
|
- First choice ICS/LABA DPI for asthma and COPD.
- Combination of beclometasone and formoterol
- For asthma: dry powder inhaler; beclometasone 100 micrograms,formoterol 6 micrograms dose and beclometasone 200 micrograms,formoterol 6 micrograms dose
- For COPD with FEV1<50%: dry powder inhaler; beclometasone100 micrograms, formoterol 6 micrograms dose only in line with the product guidance
|
|
|
Budesonide and formoterol
(Fobumix Easyhaler®)
|
First Choice
|
- First choice ICS/LABA DPI for asthma.
- Can be used in a MART regime.
- Prescribe by brand
- Combination of budesonide and formoterol fumarate dihydrate
- Breath-actuated dry powder inhaler 80 micrograms/4.5micrograms,160 micrograms/ 4.5 micrograms and 320 micrograms/9 micrograms
- For the treatment of asthma and COPD within product licence
- Most cost effective option July 2018
|
|
|
Budesonide and formoterol
(DuoResp Spiromax®)
(DPI)
|
Formulary
|
- No new prescribing. Existing patients only.
- Low strength can be used in a MART regime.
- Prescribe by brand.
- Combination of budesonide and formoterol fumarate dihydrate
- Dry Powder Inhaler 320micrograms/9 micrograms (equivalent to 400/12)and 160micrograms/4.5 micrograms (equivalent to 200/6)
- For the treatment of asthma and COPD within product licence
|
|
|
Budesonide and formoterol
(Symbicort®)
(DPI)
|
Formulary
|
- No new prescribing. Existing patients only.
- Can be used in a MART regime.
- Prescribe by brand.
- Combination of budesonide and formoterol
- Turbohaler dry powder inhaler DPI 100/6; 200/6; 400/12
- Notes: Symbicort Turbohaler is licensed for both asthma and COPD;
|
|
|
Fluticasone propionate and salmeterol
( Seretide Accuhaler®)
(DPI)
|
Formulary
|
-
BaNEs & Salisbury
- Non-formulary Swindon
- MDI 100/50, 250/50, 500/50
- No new prescribing
- Review existing patients, to see if could switch to first-line options
- Licensed for COPD but the Evohaler is not-many patients with COPD are using the Seretide 250 Evohaler
- The cost of Seretide Accuhaler 500 (one puff bd) is significantly less than Seretide 250 Evohaler (two puffs bd). It delivers exactly the same medication as for the same number of days but costs £20 less per unit
- NB -Swindon, for use in adults, all strengths have been removed from formulary, it is accepted that there may be a very small amount of non-formulary prescribing in the exceptional circumstance that all formulary options have been exhausted.
|
|
|
Fluticasone propionate and salmeterol
(Sirdupla®, Airflusal®,Seretide®)
(pMDI)
|
Formulary
|
- BaNES and Salisbury
- Non-formulary Swindon(except Seretide 50 Evohaler)
- No new prescribing.
- Review existing patients, to see if could switch to first-line options.
- Airflusal®aerosol inhalation MDI 25/125, 25/250.For asthma >18years of age. NB only to be used for new patients
- Sirdupla ®aerosol inhalation MDI 125/25, 250/25 For asthma >18years of age - NB no lower strength. Prescribe by brand.
- Seretide®Evohaler aerosol inhalation MDI 50/25, 125/25, 250/25
- Notes: The higher doses (125 and 250) are only advised in step 4 of the management of asthma in adults.
- It is envisaged that existing adult patients will be switched to either Sirdupla ®MDI / AirFluSal or Fostair ® MDI, depending on indication, although it is accepted that there may be a very small amount of non-formulary prescribing in the exceptional circumstance that all formulary options have been exhausted.
|
|
|
|
|
|
|
| .... |
Key |
|
|
|
|
Cytotoxic Drug
|
|
|
Controlled Drug
|
|
High Cost Medicine
|
|
Cancer Drugs Fund
|
|
NHS England |
|
Homecare |
|
CCG |
|
High Cost Drug Approval System |
|
Traffic Light Status Information
|
|
|
