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 Formulary Chapter 3: Respiratory system - Full Chapter
Notes:

*Important*

The NENC ICB Respiratory Network recommends that all inhalers should be prescribed by brand for patient safety, to ensure that the correct device is dispensed to support correct technique and avoid patient confusion and medication errors.

Choice of inhaler device should be based on patient ability to use. Devices should be chosen based on availability for the type of drug to be prescribed and the patient’s ability to use it.

Refer to local guidelines for information on preferred options.

Note: All new patients should be started on the updated formulary choices as per local/national guidelines.

When inhalers are removed from the formulary, existing, stable, patients should continue to receive the non-formulary device. Treatment should not be changed unless a full face to face review has been conducted.
Chapter Links...
Link   BTS/SIGN British Guideline on the Management of Asthma
Link   County Durham and Tees Valley COPD Treatment Guide
Link   County Durham and Tees Valley Adult Asthma Inhaler Guide
Link   County Durham and Tees Valley Paediatric Asthma Inhaler Guide
Link   North of Tyne, Gateshead and North Cumbria - Asthma in Children Summary Guideline
Link   North of Tyne, Gateshead and North Cumbria - COPD Management Guide
Link   North of Tyne, Gateshead and North Cumbria - Paediatric Asthma Inhaler Guidance (Children under 5 years)
Link   South Tyneside and Sunderland - Asthma Guidance (RS1)
Link   South Tyneside and Sunderland - Guidance for Choice of Inhalers for Asthma (RS2)
Link   South Tyneside and Sunderland - Guideline for the treatment of COPD (RS3)
Link   South Tyneside and Sunderland - Guideline for the Choice of Inhalers for COPD (RS4)
Link   NICE NG80: Asthma: diagnosis, monitoring and chronic asthma management
Link   NICE NG115: Chronic obstructive pulmonary disease in over 16s: diagnosis and management
Link   MHRA Drug Safety Update (July 2018): Pressurised metered dose inhalers (pMDI): risk of airway obstruction from aspiration of loose objects
Link   NENC Regional ‘At A Glance Carbon Footprint Guidance’
Link   NICE TA10: Asthma inhaler devices (children under 5)
Link   NICE TA38: Asthma inhaler devices (older children)
Link   North Cumbria - Paediatric doses of inhaled corticosteroids
Link   North East and North Cumbria Clinical Network Guide - Supporting Greener Respiratory Care
 Details...
03.01.01.01  Expand sub section  Selective Beta2 agonists
 note 

**The propellants used in pressurised Metered Dose Inhalers (pMDIs) have a high carbon footprint. Dry Powder Inhalers (DPIs) are now first choice for all of the different inhaler classes and should be used wherever this is clinically appropriate**
03.01.01.01  Expand sub section  Short-acting beta2 agonists
Salbutamol
View adult BNF View SPC online View childrens BNF 		Formulary
Green
  • REFER TO LOCAL GUIDELINES FOR ADVICE ON PREFERRED CHOICE
  • Easyhaler® breath actuated dry powder inhaler  100 mcg/puff (DPI) 
  • Accuhaler® breath actuated dry powder inhaler 200 mcg/puff (DPI)
  • 100 mcg/puff CFC-free MDI - Salamol® (pMDI)
  • 100 mcg/puff breath actuated CFC-free MDI (pMDI)
    • Airomir® Autohaler  
      • Salamol® Easi-Breathe - alternative for patients hypersensitive to lactose or milk protein
  • 2.5mg in 2.5ml & 5mg in 2.5ml nebules (Medicine Supply Notification 028 - Supply issue with salbutamol 2.5mg/2.5ml nebuliser liquid unit dose vials)
  • 2mg in 5ml sugar-free oral solution

 

 
Link  National Patient Safety Alert - Shortage of salbutamol 2.5mg/2.5ml and 5mg/2.5ml nebuliser liquid unit dose vials (26 February 2024)
Link  MHRA Drug Safety Update (Aug 2022): Nebulised asthma rescue therapy in children: home use of nebulisers in paediatric asthma should be initiated and managed only by specialists
 
Salbutamol Injection
View adult BNF View SPC online View childrens BNF 		Formulary
Red
  • 500 mcg in 1ml & 5mg in 5ml injections  

 

 
 
Terbutaline
View adult BNF View SPC online View childrens BNF 		Formulary
Green
  • Turbohaler® 500 mcg/puff (DPI)

 

 
 
Terbutaline Injection
View adult BNF View SPC online View childrens BNF 		Formulary
Red
  • 500 mcg in 1ml injection

 

 
 
Terbutaline Nebules
View adult BNF View SPC online View childrens BNF 		Formulary
Red
  • 2.5mg/ml nebuliser solution



 

 
Link  MHRA Drug Safety Update (Aug 2022): Nebulised asthma rescue therapy in children: home use of nebulisers in paediatric asthma should be initiated and managed only by specialists
 
03.01.01.01  Expand sub section  Long-acting beta2 agonists
 ....
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 children's BNF
click to search medicines.org.uk
 Link to SPCs
Cytotoxic Drug
 Cytotoxic Drug
CD
 Controlled Drug
High Cost Medicine
 High Cost Medicine
NHSE
 NHS England
Homecare
 Homecare
CCG
 CCG

Traffic Light Status Information

Status Description

Red

 Drugs for hospital use only. The responsibility for initiation and monitoring treatment should rest with an appropriate hospital clinician and the drug should be supplied through the hospital throughout the duration of treatment. In some very exceptional circumstances (e.g. due to distance from the hospital, storage, supply or mobility/transport problems) it may be appropriate for the GP to be asked to prescribe a Red drug. This should be negotiated on an individual patient basis and should only be done with the GP’s prior informed agreement where the roles of the GP and hospital services are clearly defined and agreed. The GP should not feel under pressure to prescribe in these circumstances. For all RED drugs automatically added to the formulary in response to a positive NICE TA: Prescribers need to ensure that local Trust new drug governance procedures and pharmacy processes are followed before any prescribing.  

Amber

 Drugs initiated by hospital specialist, but where continuing treatment by GPs may be appropriate under a shared care arrangement. The specialist should send the GP a copy of the shared care agreement to sign. The GP should sign the shared care agreement, or indicate they do not want to be part of such an agreement, and return a copy back to the specialist. Shared care guidelines are available or are being developed for most of the drugs listed as Amber. If no shared care guideline is available, the hospital specialist should provide the patient’s GP with sufficient information and support to allow treatment to be continued and managed safely in primary care.  

Green plus

 Drugs normally recommended or initiated by a specialist (hospital or GP with an extended role https://www.rcgp.org.uk/gpwer), but can be safely maintained in primary care with very little or no monitoring required. In some cases there may be a further restriction for use outlined - these will be defined in each case. Provision of additional information, or an information leaflet, may be appropriate in some cases to facilitate continuing treatment by GPs.  

Green

 Drugs where prescribing by GPs is appropriate. Can be initiated and prescribed in all care settings, and if appropriate, discontinued without recourse to secondary care.  

Black

 NOT APPROVED: Drugs that have been considered by NTAG or the NENC ICB Medicines Subcommittee (or other approved body) and are not approved for prescribing within the North East and North Cumbria.   

Brown

 UNDER REVIEW: drugs whose current formulary status or RAG status is currently under review.  

Not Recomended

 NOT REVIEWED: Drugs that haven not been reviewed yet. This usually means that an application is in progress. These drugs are not normally considered appropriate for prescribing in the North East and North Cumbria until such time that a decision is taken on their formulary status.  

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