| Formulary Chapter 3: Respiratory system - Full Chapter
|
| Chapter Links... |
 BCICB Asthma Treatment Guidelines - Adolescents 12-17 years old |
| BCICB Asthma Treatment Guidelines - Adults 18+ |
| BCICB Asthma Treatment Guidelines For Children Under 12 |
| BCICB COPD Inhaler Treatment Guidelines |
| BCICB Difficult Asthma Referral Pathway - Adults 18+ |
| Greener Inhaler Guide Switching Information |
| How to improve respiratory control in asthma and COPD |
| NICE CG115: Chronic obstructive pulmonary disease in over 16s: diagnosis and management |
| NICE TA10: Guidance on the use of inhaler systems (devices) in children under the age of 5 years with chronic asthma |
| NICE TA138: Inhaled corticosteroids for the treatment of chronic asthma in adults and in children aged 12 years and over |
| NICE TA38: Inhaler devices for routine treatment of chronic asthma in older children (aged 5–15 years) |
| COVID-19: information for the respiratory community |
| Details... |
| 03.02 |
Corticosteroids |
|
|
Beclometasone and formoterol (Fostair®)
|
Formulary
|
Licensed for both asthma and COPD
Asthma - use lowest effective dose. Consider step down at each review. Consider switch if appropriate
Alternative to Seretide Evohaler / Seretide 250 Accuhaler
Note: when switching patients already using Beclometasone 250mcg CFC inhaler (e.g. Clenil), Fostair 100/6 can be prescribed and dose adjusted according to response
How to use a Metered Dose Inhaler
How to use a Metered Dose Inhaler with a Large Volume Spacer Device
How to use a Metered Dose Inhaler with a Small Volume Spacer Device
|
|
|
Beclometasone and formoterol (Fostair® NEXThaler®)
|
Formulary
|
How to use a NEXThaler Inhaler
|
|
|
Beclometasone Dipropionate (Clenil Modulite®)
|
Formulary
|
May 2020 - see Clenil® Modulite® 100mcg (beclometasone): release of batch specific variation
How to use a Metered Dose Inhaler
How to use a Metered Dose Inhaler with a Large Volume Spacer Device
How to use a Metered Dose Inhaler with a Small Volume Spacer Device
|
|
|
Budesonide
(Nebuliser Liquid)
|
Formulary
|
|
|
|
Budesonide
|
Formulary
|
- Dry powder Inhaler
- Easyhaler
- Prescribe by brand
How to use a Turbohaler Inhaler
How to use an Easyhaler Inhaler
|
|
|
Budesonide (Easyhaler® )
|
Formulary
|
How to use an Easyhaler Inhaler
|
|
|
Budesonide (Pulmicort Respules®)
(Nebuliser Liquid)
|
Formulary
|
|
|
|
Budesonide (Pulmicort Turbohaler®)
|
Formulary
|
How to use a Turbohaler Inhaler
|
|
|
Budesonide and Formoterol (Fobumix Easyhaler®)
|
Formulary
|
How to use an Easyhaler Inhaler
|
|
|
Budesonide and Formoterol 100/6 (Symbicort Turbohaler®)
|
Formulary
|
- For treatment of asthma only
- Use lowest effective dose. Consider step down at each review.
- Prescribe by brand to ensure patient receives the device they are used to.
How to use a Turbohaler Inhaler
|
|
|
Budesonide and Formoterol 200/6 (Symbicort Turbohaler®)
|
Formulary
|
For Asthma, maintenance and reliever therapy in adults and adolescents (12 years and older) with mild asthma
How to use a Turbohaler Inhaler
|
|
|
Fluticasone
|
Formulary
|
- Flixonase Nasal Drops
- Flixotide Nebuliser Liquid
|
|
|
Fluticasone and salmeterol (Seretide®)
(Inhaler)
|
Formulary
|
For paediatric use ONLY (i.e. up to 18 years of age)
- Seretide Evohaler- 50mg and 125mg only .
- Should be prescribed by the intended brand to ensure patients are maintained on the formulation they are used to.
How to use an Accuhaler Inhaler
How to use a Metered Dose Inhaler
How to use a Metered Dose Inhaler with a Large Volume Spacer Device
How to use a Metered Dose Inhaler with a Small Volume Spacer Device
|
|
|
Fluticasone furoate & vilanterol (Relvar Ellipta®)
|
Formulary
|
How to use an Ellipta Inhaler
|
|
|
Fluticasone Nasal Spray
|
Formulary
|
BRANDS
|
|
|
Fluticasone Nasal Spray (Avamys®)
|
Formulary
|
|
|
|
Fluticasone propionate (Flixotide®)
|
Formulary
|
How to use an Accuhaler Inhaler
How to use a Metered Dose Inhaler
How to use a Metered Dose Inhaler with a Large Volume Spacer Device
How to use a Metered Dose Inhaler with a Small Volume Spacer Device
|
|
|
Mometasone
(Spray)
|
Formulary
|
|
|
|
Prednisolone
|
Formulary
|
|
 UKMI Q&A: Is there any evidence to support the use of enteric coated (EC) over uncoated prednisolone tablets?
|
|
|
|
|
|
|
| 03.02.01 |
Inhaled Corticosteroids |
|
|
| 03.02.02 |
Combination products (ICS+LABA) for asthma |
|
|
| 03.02.02 |
Low dose |
|
|
| 03.02.02 |
Moderate dose |
|
|
| 03.02.02 |
High dose |
|
|
| 03.02.03 |
Combination products (ICS+LABA) for COPD |
|
|
| 03.02.03 |
Triple Therapy products for COPD |
|
|
Beclometasone/formoterol/glycopyrronium (Trimbow 87/5/9 ®)
|
Formulary
|
Trimbow 87/5/9 is licensed for Moderate-to-severe chronic obstructive pulmonary disease and Asthma maintenance therapy
|
 How to use a Metered Dose Inhaler
How to use a Metered Dose Inhaler with a Large Volume Spacer Device
How to use a Metered Dose Inhaler with a Small Volume Spacer Device
|
Beclometasone/formoterol/glycopyrronium
|
Formulary
|
|
How to use a Metered Dose Inhaler
How to use a Metered Dose Inhaler with a Large Volume Spacer Device
How to use a Metered Dose Inhaler with a Small Volume Spacer Device
|
Beclometasone/formoterol/glycopyrronium (Trimbow 172/5/9 ®)
|
Formulary
|
Note:
-Two strengths of Trimbow available
* Trimbow 172/5/9
* Trimbow 87/5/9
-Trimbow 172/5/9 is licensed for Asthma maintenance therapy only
|
How to use a Metered Dose Inhaler
How to use a Metered Dose Inhaler with a Large Volume Spacer Device
How to use a Metered Dose Inhaler with a Small Volume Spacer Device
|
Beclometasone/formoterol/glycopyrronium (Trimbow NEXThaler®)
|
Formulary
|
How to use a NEXThaler Inhaler
|
|
|
Fluticasone/vilanterol/Umeclidinium (Trelegy Ellipta®)
|
Formulary
|
|
How to use an Ellipta Inhaler
|
| .... |
| Non Formulary Items |
Beclometasone (Clipper®)
|
Non Formulary
|
Modified release tablets |
|
|
Beclometasone and formoterol (Luforbec®)
|
Non Formulary
|
|
|
|
Beclometasone Dipropionate (Easyhaler® )
|
Non Formulary
|
|
How to use an Easyhaler Inhaler
|
Beclometasone Dipropionate (Kelhale® )
|
Non Formulary
|
How to use a Metered Dose Inhaler
How to use a Metered Dose Inhaler with a Large Volume Spacer Device
How to use a Metered Dose Inhaler with a Small Volume Spacer Device
|
|
|
Beclometasone Dipropionate (Qvar®)
|
Non Formulary
|
- Qvar
- Qvar Autohaler
- Qvar Easi-Breathe
|
|
|
Beclometasone Dipropionate (Soprobec ®)
|
Non Formulary
|
How to use a Metered Dose Inhaler
How to use a Metered Dose Inhaler with a Large Volume Spacer Device
How to use a Metered Dose Inhaler with a Small Volume Spacer Device
|
|
|
Budesonide
(Spray)
|
Non Formulary
|
|
|
|
Budesonide (Budelin Novolizer®)
|
Non Formulary
|
How to use a Turbohaler Inhaler
|
|
|
Budesonide and formoterol (DuoResp Spiromax®)
|
Non Formulary
|
- DuoResp Spiromax 160/4.5 is therapeutically equivalent to Symbicort Turbohaler 200/6
- DuoResp Spiromax 320/9 is therapeutically equivalent to Symbicort Turbohaler 400/12
- Prescribe by brand to ensure patient receives the device they are used to
How to use a Spiromax Inhaler
|
|
|
Budesonide and Formoterol (Symbicort pMDI®)
|
Non Formulary
|
|
|
|
Budesonide and Formoterol (WockAIR®)
|
Non Formulary
|
|
|
|
Ciclesonide (Alvesco®)
(Inhaler)
|
Non Formulary
|
How to use a Metered Dose Inhaler
|
|
|
Fluticasone and formoterol (Flutiform®)
|
Non Formulary
|
How to use a Metered Dose Inhaler
How to use a Metered Dose Inhaler with a Large Volume Spacer Device
How to use a Metered Dose Inhaler with a Small Volume Spacer Device |
|
|
Fluticasone and salmeterol
(Pressurised inhalation)
|
Non Formulary
|
BRANDS
- Airflusal
- Aloflute
- Avenor
- Combisal
- Sirdupla- No dose counter although cost effective
- Sereflo -Even though cost effective and has dose counter, licensed for >18 yrs and clinicians would rather have patients on formoterol rather than salmeterol
|
|
|
Fluticasone and salmeterol
(Inhalation powder)
|
Non Formulary
|
BRANDS
- Airflusal Forspiro
- Fixkoh Airmaster
- Fusacomb Easyhaler
- Seretide Accuhaler
- Stalpex
|
|
|
Fluticasone and salmeterol (Seretide 500 Accuhaler®)
|
Non Formulary
|
|
|
|
Fluticasone and salmeterol (Seretide®)
(Inhaler)
|
Non Formulary
|
Seretide 250 Evohaler- Black from 23rd May 2023.
Ok for historic patients
- Should be prescribed by the intended brand to ensure patients are maintained on the formulation they are used to.
|
|
|
Mometasone (Asmanex®)
|
Non Formulary
|
|
|
|
Mometasone Furoate (Nasonex Spray®)
|
Non Formulary
|
Prescribe generically |
|
|
Montelukast (Singulair® )
(Oral presentations)
|
Non Formulary
|
Use in line with recommendations in BTS-SIGN asthma guideline |
|
|
| |
Key |
 |
Restricted Drug |
 |
Unlicensed |
|
|
Link to adult BNF
|
|
|
Link to children's BNF
|
|
|
Link to SPCs
|
|
Cytotoxic Drug |
|
Controlled Drug |
|
|
High Cost Medicine |
|
Cancer Drugs Fund |
|
NHS England |
|
Homecare |
|
ICB |
|
Low carbon footprint |
|
Medium carbon footprint |
|
High carbon footprint |
|
| Status |
Description |
|
All Settings
Suitable for initiation, ongoing prescribing, and discontinuation in both primary and secondary care settings. They are generally familiar, frequently used therapies that can be started within their licensed indications without specialist oversight. |
|
Specialist only
Designated for initiation, ongoing prescribing, monitoring, exclusively by a specialists either in a hospital or as part of a specialist service (to note this could be in a non-hospital setting). Primary care should neither start nor continue these treatments except as part of a specialist service. A specialist could be either a medical or non-medical prescriber. |
|
Specialist advice
Prescribers in primary care should seek advice and a recommendation from a specialists prior to initiating a medicine. Once agreed with a specialist, medicines can be initiated, prescribed and monitored in primary care without a formal shared-care agreement. |
|
Specialist initiation
Medicines in this category require a specialist to start therapy, titrate dosage, and assess initial efficacy or tolerability. Once stabilised, prescribing responsibility may transfer to primary care without the need for a formal shared-care agreement. |
|
Shared care agreement
Prescribing responsibility can be shared across health settings and between specialists and GPs only when formal shared care arrangement has been made. For example, there may be extensive and complex monitoring requirements or significant safety concerns (note would need a national policy on this to define the criteria for requiring a formal SCA), this will be produced once nationally. |
|
Do not prescribe
Not approved for routine prescribing in primary or secondary care. For example, because they are agents classified in the BNF as “not NHS” or “Drugs of Low Clinical Value”, or they are products on NICE’s “do not do” list or NHS England’s “should not routinely prescribe” list. |
|
Self Care
Not for routine prescribed in primary or secondary care unless as part of care for a long term condition. Instead, patients should be encouraged to self care with support from community pharmacy. |
|
Medicines which are suitable for initiation and maintenance prescribing by primary and secondary care clinicians. These medicines should be initiated and prescribed within their licensed indications |
|
Amber Specialist Initiation: Initiation and maintenance of prescribing by Specialists and transfer to Primary Care prescribing when appropriate. This may be supported by a RICaD, annotated within the formulary entry. |
|
Amber Shared Care: Initiation and maintenance of prescribing by Specialists and transfer to Primary Care prescribing, in accordance with an ESCA, annotated within the formulary entry. |
|
Amber Specialist Recommendation: Initiation and maintenance of prescribing in Primary Care following recommendation from a specialist. |
|
Medicines for initiation and maintenance prescribing by Specialists (hospital or GPs with Special Interest) only |
|
Positive NICE TA and /or awaiting local clarification on place in therapy; Please contact your Medicines Optimisation team for more information. |
|
Non-formulary Medicines which APC/Trust DTC has actively reviewed and do not recommend for use. |
|
|
|
