| Formulary Chapter 3: Respiratory system - Full Chapter
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| 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/
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| Chapter Links... |
 NICE CG101: COPD guideline |
| NICE TA10: Asthma inhaler devices (children under 5) |
| NICE TA38: Asthma inhaler devices (older children) |
| Details... |
| 03.07 |
Mucolytics |
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https://www.nice.org.uk/guidance/ng115/chapter/Recommendations
Consider mucolytic drug therapy for people with a chronic cough productive of sputum.
Only continue mucolytic therapy if there is symptomatic improvement (for
example, reduction in frequency of cough and sputum production).
Do not routinely use mucolytic drugs to prevent exacerbations in people with
stable COPD. |
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Carbocisteine
(Oral)
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Formulary
 
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- Capsules 375mg
- Oral liquid 250mg/5ml
- Sachets 750mg/10ml Sugar free oral solution
- Note: liquid must still be used in patients with feeding tubes
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Ivacaftor
(Kalydeco ®)
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Formulary
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| 03.07 |
Dornase alfa |
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Dornase Alfa
(Pulmozyme®)
(Nebulised)
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Formulary
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- Nebuliser solution 2500 units in 2.5ml
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Notes:
- A Jet Nebuliser used exclusively for dornase alfa is required for administration
- To improve pulmonary function in cystic fibrosis patients with a FVC of greater than 40% predicted.
- Use on specialist respiratory advice only.
- Requirement for dornase alfa should be reviewed every 3 days.
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NHSE policy Dec 2014: Clinical Commissioning Policy: Inhaled Therapy for Adults and Children with Cystic Fibrosis
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| 03.07 |
Hypertonic Sodium Chloride |
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Hypertonic Sodium chloride for nebulisation
(MucoClear®, PulmoClear®, Nebusal®)
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Formulary
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- Nebuliser solution, sodium chloride 3%, 6%, 7%
- To be started on Specialist respiratory advice only
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| 03.07 |
Mannitol |
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Mannitol inhalation
(Osmohale ®/Aridol®)
(DPI)
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Formulary
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- For inhalation for mannitol bronchial challenge test
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Mannitol inhalation
(Bronchitol ®)
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Formulary
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- Non Formulary at RUH and SFT
- Inhalation powder, hard capsule (for use with disposable inhaler device) mannitol 40mg
- Commissioned by NHS England for use in CF as per policy A01/P/b and NICE TA266.
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NHSE Dec 2014: Clinical Commissioning Policy: Inhaled Therapy for Adults and Children with Cystic Fibrosis
NICE TA266: Cystic fibrosis - mannitol dry powder for inhalation
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| Non Formulary Items |
Lumacaftor + Ivacaftor
(Orkambi®)
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Non Formulary
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NICE TA398: Lumacaftor–ivacaftor for treating cystic fibrosis homozygous for the F508del mutation
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Mecysteine
(Visclair®)
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Non Formulary
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Key |
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Cytotoxic Drug
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Controlled Drug
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High Cost Medicine
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Cancer Drugs Fund
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NHS England |
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Homecare |
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CCG |
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High Cost Drug Approval System |
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Traffic Light Status Information
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