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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
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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...
Link   NICE CG101: COPD guideline
Link   NICE TA10: Asthma inhaler devices (children under 5)
Link   NICE TA38: Asthma inhaler devices (older children)
 Details...
03.07  Expand sub section  Mucolytics
 note 

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. 
03.07  Expand sub section  Dornase alfa
Dornase Alfa
(Pulmozyme®)
(Nebulised)
View adult BNF View SPC online 		Formulary
traffic lightRed
High Cost Medicine
  • Nebuliser solution 2500 units in 2.5ml 

  • 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.

 

 
Link  NHSE policy Dec 2014: Clinical Commissioning Policy: Inhaled Therapy for Adults and Children with Cystic Fibrosis
 
03.07  Expand sub section  Hypertonic Sodium Chloride
03.07  Expand sub section  Mannitol
 ....
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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