NHS Greater Glasgow & Clyde Area Drug and Therapeutics Committee
Greater Glasgow and Clyde Prescribing
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3 Respiratory system

3.1 Bronchodilators

The British Thoracic Society and the Scottish Intercollegiate Guidelines Network jointly produce the British Guideline on the Managment of Asthma which are available from the SIGN website (www.sign.ac.uk). Nebules should generally be used as an emergency back-up to other treatments rather than used routinely. The prescribing resources page contains useful resources for prescribing inhaler devices including device guides and patient information leaflets.

3.1.1 Adrenoceptor agonists

3.1.1.1 Selective beta2 agonists

3.1.1.1.1 Short-acting bronchodilators

Where a patient can use it, a metered dose inhaler (MDI) is the device of choice based on cost.

Preferred list
SALBUTAMOL

Prescribing Notes:

Preferred devices:

  • 1st choice: Salbutamol 100 microgram MDI (with or without spacer device)
  • 2nd choice: Salbutamol 100 microgram Easyhaler 

Salbutamol inhalers generally should not be prescribed to be used regularly, but should be used on a when required basis. Metered-dose inhalers (MDIs) are the most cost-effective devices

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/2886.htm

Total Formulary
SALBUTAMOL (SALAMOL) (Easi-Breathe inhaler)

Prescribing Notes:

Salbutamol inhalers generally should not be prescribed to be used regularly, but should be used on a when required basis. Metered-dose inhalers (MDIs) are the most cost-effective devices

SALBUTAMOL (Nebules)

Prescribing Notes:

Nebules should generally be used as an emergency back-up to other treatments rather than used routinely. 

TERBUTALINE (Bricanyl) (dry powder inhaler)

Prescribing Notes:

To prevent confusion, prescribe inhaler devices by brand name.

Nebules should generally only be used as an emergency back-up to other treatments rather than used routinely.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/2892.htm

3.1.1.1.2 Long-acting bronchodilators

In asthma, at step 3 in the BTS/SIGN guidelines, inhaled long-acting beta2 agonists are recommended as first line add-on therapy. A long-acting beta agonist would not normally be prescribed in addition to a steroid and bronchodilator combination device.

Preferred list
FORMOTEROL

Prescribing Notes:

Preferred brands and devices:

  • 1st Choice: Formoterol Easyhaler (dry powder inhaler)
  • 2nd Choice: Atimos Modulite (aerosol inhaler)

To prevent confusion, prescribe inhaler devices by brand name.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/37302.htm

Total Formulary
OLODATEROL (STRIVERDI RESPIMAT) (solution for inhalation)

Prescribing Notes:

To prevent confusion, prescribe inhaler devices by brand name.

BNF Link: https://www.medicinescomplete.com/mc/bnf/current/PHP34727-olodaterol.htm

3.1.1.1.3 Combination inhaled devices

3.1.1.2 Other adrenoceptor agonists

3.1.2 Antimuscarinic bronchodilators

Preferred list
TIOTROPIUM (dry powder)

Restrictions:

For use as a maintenance bronchodilator in COPD. To prevent confusion, prescribe inhaler devices by brand name. Preferred List use of tiotropium only relates to use in COPD. For restrictions on use in asthma, see the entry in the Total Formulary.

Prescribing Notes:

Preferred brand and device:

  • Braltus® Zonda

To prevent confusion, prescribe inhaler devices by brand name.  

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/119674.htm

ACLIDINIUM BROMIDE (Eklira Genuair) (dry powder inhaler)

Prescribing Notes:

To prevent confusion, prescribe inhaler devices by brand name.

For the relevant SMC advice click here

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/PHP18568-aclidinium-bromide.htm?q=aclidinium&t=search&ss=text&p=1#_hit

UMECLIDINIUM (Incruse Ellipta) (dry powder inhaler)

Prescribing Notes:

To prevent confusion, prescribe inhaler devices by brand name.

BNF Link: https://www.medicinescomplete.com/mc/bnf/current/PHP34922-umeclidinium.htm?q=UMECLIdinium&t=search&ss=text&p=1#_hit

Total Formulary
IPRATROPIUM BROMIDE (nebules)

Prescribing Notes:

Ipratropium inhalers are not included in the GGC Formulary.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/59966.htm#_59966

TIOTROPIUM (SPIRIVA RESPIMAT) (solution for inhalation)

Restrictions: Use for adults with asthma is restricted to initiation by clinicians experienced in the management of asthma as add-on treatment in adults at step 4 with poorly controlled asthma (at least one course of oral steroids for a severe exacerbation in the last year) who have persistent airflow obstruction (post-bronchodilator FEV1 of less than 80% predicted).

Prescribing Notes:

For use in the management of COPD, see the entry in the Preferred List.

To prevent confusion, prescribe inhaler devices by brand name.

BNF Link: https://www.medicinescomplete.com/mc/bnf/current/PHP1798-tiotropium.htm?q=tiotropium&t=search&ss=text&p=1#_hit

3.1.2.1 Antimuscarinic combination inhalers

Preferred list
ACLIDINIUM AND FORMOTEROL (DUAKLIR GENUAIR) (dry powder inhaler)

Prescribing Notes:

To prevent confusion, prescribe inhaler devices by brand name.

UMECLIDINIUM AND VILANTEROL (ANORO ELLIPTA) (dry powder inhaler)

Prescribing Notes:

To prevent confusion, prescribe inhaler devices by brand name.

BNF Link: https://www.medicinescomplete.com/mc/bnf/current/PHP34764-anoro-ellipta.htm#PHP34764-anoro-ellipta

Total Formulary
INDACATEROL AND GLYCOPYRRONIUM BROMIDE (ULTIBRO BREEZHALER)

Prescribing Notes:

To prevent confusion, prescribe inhaler devices by brand name.

TIOTROPIUM AND OLODATEROL (SPIOLTO RESPIMAT)

Prescribing Notes:

To prevent confusion, prescribe inhaler devices by brand name.

3.1.3 Theophylline

Total Formulary
AMINOPHYLLINE

Prescribing Notes:

Prescribe by brand name.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/2939.htm

THEOPHYLLINE

Prescribing Notes:

Preferred brand:

  • Uniphyllin®

Prescribe by brand name.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/2929.htm