netFormulary NHS
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
 Formulary Chapter 3: Respiratory system - Full Chapter

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 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. 


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

Chapter Links...
03.03  Expand sub section  Cromoglicate, related therapy and leukotriene receptor antagonists
03.03.01  Expand sub section  Cromoglicate and related therapy

Please note use of sodium cromoglycate and nedocromil sodium is not recommended.

03.03.02  Expand sub section  Leukotriene receptor antagonists
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  • Granules 4mg sachets sugar-free (6 months to 5 years of age)
  • Chewable tablets 4mg (2 to 5 years of age)
  • Chewable tablets 5mg (6 to 14 years of age)
  • Tablets 10mg (>14 years of age)
  • NICE guidance (NG80, November 2017) recommends an LTRA as the first add-on maintenance therapy with ICS and SABA inhalers for the treatment in asthma. A LABA is an option (with/without the LTRA) in addition to an ICS if asthma remains uncontrolled. This is a more cost effective model. 
  • Existing BTS/SIGN continues the long-held view that low dose ICS should be followed by addition of LABA (in line with international guidelines such as GINA).
  • Head to head comparisons of ICS/LABA compared to ICS/LTRA have favoured ICS/LABA for effectiveness in adults (inconclusive in children).


03.03.03  Expand sub section  Phosphodiesterase type-4 inhibitors
Roflumilast (Daxas)
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  • ONLY for initiation by a Respiratory specialist, for the treatment of COPD in adults, in line with NICE TA 461. 
  • Tablet 250mcg (for intiation only) 500microgram (maintenance)
  • Patients should be referred only if:
    i) the disease is severe, defined as a forced expiratory volume in 1 second (FEV1 ) after a bronchodilator of less than 50% of predicted normal, and ii) they have had 2 or more exacerbations in the previous 12 months despite triple inhaled therapy with a long-acting muscarinic antagonist, a long-acting beta-2 agonist and an inhaled corticosteroid.
Link  For Roflumilast guidance see page 7-8 of the BSW COPD guidance
Link  NICE TA461 : Roflumilast for treating chronic obstructive pulmonary disease
 Non Formulary Items
(Tilade® CFC-free inhaler)

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Non Formulary
Sodium Cromoglicate

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Non Formulary
Sodium Cromoglicate
(Comogen Easi-Breathe®)

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Non Formulary
Sodium Cromoglicate

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Non Formulary

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Non Formulary
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
Track Changes
Display tracking information
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Link to adult BNF
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Link to SPCs
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHS England
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.