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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...
03.02.02  Expand sub section  Compound Corticosteroid/ Long acting beta-agonist inhalers
Fluticasone furoate & vilanterol
(Relvar Ellipta)
(DPI)
View adult BNF View SPC online
First Choice
traffic lightGreen

 

  • 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)
View adult BNF View SPC online
First Choice
traffic lightGreen
  • First choice ICS/LABA pMDI for asthma and COPD and the only licensed pMDI for COPD
  • Aerosol inhalation MDI 120 dose unit beclometasone100 micrograms, formoterol 6 micrograms dose andbeclometasone 200 micrograms, formoterol 6 micrograms dose 

  • Adults over 18 years only. (dose = 1-2 puffs twice daily,max 4 puffs twice daily) 
 
Beclometasone and formoterol
(Fostair NEXThaler)
(DPI)
View adult BNF View SPC online
First Choice
traffic lightGreen
  • 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)
View adult BNF View SPC online
First Choice
traffic lightGreen
  • 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)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • 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)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • 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)
View adult BNF View SPC online
Formulary
  • Green  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)
View adult BNF View SPC online
Formulary
  • Green 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
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

Traffic LightRed

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

Traffic LightAmber

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

Traffic LightAmber 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.  

Traffic LightGreen

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

Traffic LightSelf

Suitable for patient to be directed to buy themselves  

Traffic LightGrey

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

Traffic LightBlack

(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.   

Traffic LightRed 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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