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3. Respiratory System

NICE TA38 - Inhaler devices for routine treatment of chronic asthma in older children (aged 5–15 years)

NICE TA10 - Guidance on the use of inhaler systems (devices) in children under the age of 5 years with chronic asthma

NICE NG9 - Bronchiolitis in children

Formoterol
BNF | BNFC | SPC

Dry Powder for inhalation 12microgram / metered inhalation

Salbutamol
BNF | BNFC | SPC

Aerosol inhaler 100micrograms/metered dose

Breath actuated inhaler 100micrograms/metered inhalation

Dry powder inhaler 200micrograms/dose (Accuhaler) Nebuliser solution 2.5mg, 5mg 

2.5mg nebules recommended for COPD as 5mg have no additional benefit

Salmeterol
BNF | BNFC | SPC

Aerosol Inhaler 25micrograms/metered inhalation

Dry Powder Inhaler 50micrograms/dose(Accuhaler)

Terbutaline
BNF | BNFC | SPC

Dry Powder Inhaler 500micrograms/metered dose (Turbohaler)

Braltus Zonda (tiotropium)
BNF | BNFC | SPC

10mcg inhalation powder capsules with device

Tees COPD Management Guidelines

Eklira Genuair (aclidinium bromide)
BNF | BNFC | SPC

Inhalation powder, 375micrograms per dose (as aclidinium bromide) delivers 322micrograms aclidinium per dose

Tees COPD Management Guidelines

Ipratropium
BNF | BNFC | SPC

Aerosol inhaler 20microgram/metered dose

Nebuliser solution 250micrograms/ml

Seebri Breezhaler (glycopyrronium bromide)
BNF | BNFC | SPC

Inhalation powder, hard capsules 44microgram (as Glycopyrronium)

Tees COPD Management Guidelines

Spiriva (tiotropium)
BNF | BNFC | SPC

Solution for inhalation 2.5micrograms/metered dose (Respimat) Inhalation Powder

Hard Capsules 18micrograms (for use with Handihaler)

Tees COPD Management Guidelines

Duaklir Genuair (aclidinium/formoterol)
BNF | BNFC | SPC

Dry powder inhaler 340micrograms/12micrograms per metered dose

Tees COPD Management Guidelines

Spiolto Respimat - (tiotropium/olodaterol)
BNF | BNFC | SPC

Solution for inhalation 2.5micrograms/2.5 microgram per metered dose

Tees COPD Management Guidelines

Ultibro breezhaler (glycopyrronium / indacaterol)
BNF | BNFC | SPC

85micrograms/43micrograms inhalation powder capsules.

Tees COPD Management Guidelines

Theophylline
BNF | BNFC | SPC

MR Tablets 175mg, 250mg (Neulin SA)

MR Tablets 200mg, 300mg, 400mg (Uniphyllin Continus)

MR Capsules 60mg, 125mg, 250mg (Slophyllin) 

Must be prescribed by brand

Adults: NICE TA138, Children: NICE TA131

Budesonide
BNF | BNFC | SPC

Dry Powder Inhaler 100microgram, 200microgram, 400microgram/metered dose (Easyhaler, Turbohaler)

Beclometasone Dipropionate (Clenil)
BNF | BNFC | SPC

Aerosol inhaler 50microgram, 100microgram, 200 microgram, 250microgram/ metered dose (Clenil Modulite).

Beclometasone inhalers are not interchangeable and should be prescribed by brand

Fluticasone
BNF | BNFC | SPC

Aerosol Inhaler 50microgram, 125microgram/metered dose

Dry Powder Inhaler  50microgram, 100microgram, 250microgram/metered dose (Accuhaler)

Mometasone
BNF | BNFC | SPC

200mcg, 400mcg dry powder inhaler - 60 doses

Ciclesonide
BNF | BNFC | SPC

Tees Do Not Prescribe/Grey List

There are alternative inhaled corticosteroids available at a lower cost. Lack of long-term data on clinical outcomes.

DuoResp Spiromax (Formoterol / budesonide)
BNF | BNFC | SPC

Dry Powder Inhaler 160 μg / 4.5 μg, 320 μg / 9 μg

Only For Adults aged 18years or older

Tees CCG COPD Treatment Guide

Flutiform (Fluticasone / formoterol)
BNF | BNFC | SPC

50/5microgram, 125/5microgram, 250/10microgram MDI.

Fostair (beclometasone / formoterol)
BNF | BNFC | SPC

Aerosol Inhalation 100/6micrograms

Tees CCG COPD Treatment Guide

Tees Asthma Inhaler Choices

Fostair Nexthaler (beclometasone / formoterol)
BNF | BNFC | SPC

Powder breath actuated inhaler 100/6micrograms, 200/6

Tees CCG COPD Treatment Guide

Tees Asthma Inhaler Choices

Relvar Ellipta (fluticasone / vilanterol)
BNF | BNFC | SPC

Dry Powder Inhaler 92/22microgram, 184/22microgram

Tees CCG COPD Treatment Guide

Seretide (fluticasone / salmeterol)
BNF | BNFC | SPC

Non-formulary for new patients – see Tees COPD/Asthma guidance for formulary choices

Dry Powder Inhaler 100/50microgram, 250/50microgram, 500/50microgram/metered dose

Evohaler 50/25microgram, 125/25 microgram, 250/25 microgram.

Sirdupla (fluticasone / salmeterol)
BNF | BNFC | SPC

Non-formulary for new patients – see Tees COPD/Asthma guidance for formulary choices

125/25mcg, 250/25mcg

 

Symbicort - (formoterol / budesonide)
BNF | BNFC | SPC

Dry Powder Inhaler 6/100microgram, 6/200microgram, 12/400microgram/metered dose (turbohaler)

Tees CCG COPD Treatment Guide

Combination inhalers should be prescribed by brand name to avoid confusion.

Trimbow
BNF | BNFC | SPC

Formoterol fumarate dihydrate 5 microgram, beclometasone dipropionate 87 microgram, glycopyrronium (as bromide) 9 microgram per puff MDI

Tees CCG COPD Treatment Guide

Trelegy
BNF | BNFC | SPC

Vilanterol (as trifenatate)/fluticasone furoate/umeclidinium (as bromide)
22 microgram/92 microgram/55 microgram per inhalation,
Breath-actuated dry powder inhaler.

Tees CCG COPD Treatment Guide

Montelukast
BNF | BNFC | SPC

10mg Tablets

4mg,5mg Chewable Tablets

4mg Granules

Roflumilast
BNF | BNFC | SPC

Treatment of COPD in adults with chronic bronchitis.  In line with NICE TA461

Hospital to provide the 1st months supply before GPs take over prescribing

Alimemazine
BNF | BNFC | SPC

Treatment for existing patients may continue without change until they and their NHS clinician consider it appropriate to stop

Not to be initiated for new patients

 

Cetirizine
BNF | BNFC | SPC

Tablets 10mg

Liquid 5mg/5ml 

Chlorphenamine
BNF | BNFC | SPC

Tablets 4mg

Liquid 2mg/5ml

Fexofenadine
BNF | BNFC | SPC

Tablets 120mg, 180mg

Loratadine
BNF | BNFC | SPC

Tablets 10mg

Liquid 5mg/5ml 

Mepolizumab
BNF | BNFC | SPC

Tariff-Excluded; NHSE Commissioned

Approved: NICE TA431

Omalizumab
BNF | BNFC | SPC

Tariff Excluded; CCG Commissioned (Urticaria), NHSE Commissioned (Asthma)

Approved: NICE TA278, TA339

Pharmalgen (Bee and Wasp Allergen Extracts)
BNF | BNFC | SPC

Approved: NICE TA246

Reslizumab
BNF | BNFC | SPC

Tariff Excluded; NHSE Commissioned

Approved: NICE TA479 - Severe eosinophilic asthma

 

Benralizumab
BNF | BNFC | SPC

NHSE Commissioned

Approved: NICE TA565: Benralizumab for treating severe eosinophilic asthma

Epipen
BNF | BNFC | SPC

150micrograms and 300micrograms auto-injector pen.

Jext
BNF | BNFC | SPC

150micrograms, and 300microgram auto-injector pen

Carbocisteine
BNF | BNFC | SPC

Capsules 375mg

250mg/5ml oral solution

750mg/10ml oral solution sachets

 

Dornase Alfa
BNF | BNFC | SPC

Cystic Fibrosis

Lumacaftor - Ivacaftor
BNF | BNFC | SPC

Tariff Excluded; NHSE Commissioned

Not Approved: NICE TA398

Cough and Cold Remedies
BNF | BNFC | SPC

Tees Do Not Prescribe/Grey List

There is limited clinical value for preparations such as cough mixtures, aromatic inhalations, decongestants and sore throat lozenges. For some drugs (such as decongestants) there is a potential for interaction with other medicines. 

PrescQIPP bulletin 117: DROP List 2015

Pirfenidone
BNF | BNFC | SPC

Tariff-excluded; NHSE commissioned

Idiopathic pulmonary fibrosis in adults

Approved: NICE TA504

Flutter Device
BNF | BNFC | SPC