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Guideline for Choice of Inhalers for Asthma (RS2)

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Guideline for Choice of Inhalers for Asthma (RS2) Guideline for Choice of Inhalers for Asthma (RS2) Author Medicines Optimisation Team, Sunderland CCG Approved by Sunderland Medicines Optimisation and Guideline Group Current Version 2 (19.12.18) Published on June 2018 Review date June 2020 This guideline is intended for use in primary care llt Sunderland and South Tyneside Asthma Inhaler Guide Preferred inhaler choices are shown below. Prescribe inhalers (other than salbutamol) by brand name. Abbreviations: BDP Beclometasone Dipropionate MART Maintenance and Reliever Therapy DPI Dry Power Inhaler MDI Metered Dose Inhaler ICS Inhaled Corticosteroid SABA Short Acting Beta Agonist LABA Long Acting Beta Agonist; SMART Single Maintenance and Reliever Therapy Formulary Brand name Drug Image Dose Choice Various brands include: Salbutamol Ventolin® 100micrograms Two Puffs MDI or DPI st Evohaler ® up to four 1 choice Easyhaler® times a day SABA Spacer devices are recommended with MDI Salbutamol ® Others include: Terbutaline (Bricanyl Turbohaler®) Salamol® Easi-breath Airomir autohaler Beclomethasone Dipropionate 200micrograms Clenil® (BDP) One puff 1st Choice Modulate twice a ICS only Spacer devices recommended with MDI day Standard BDP Beclomethasone Dipropionate 50micrograms One puff Qvar® 2nd Choice twice a ICS only Double potency of standard BDP day Step 1 Spacer devices recommended with MDI Beclometasone Dipropionate One puff Easyhaler® 100micrograms to 200micrograms Alternative twice a ICS only day Equivalent to BDP Qvar Beclometasone 50micrograms Two puffs Alternative Easi-breathe® twice a ICS only Double potency of standard BDP day Beclomethasone Dipropionate 200micrograms One puff Clenil® modulate 1st Choice twice a ICS only Spacer devices recommended with MDI day Standard BDP Beclomethasone Dipropionate 100micrograms One puff Qvar® 2nd Choice twice a ICS only Spacer devices recommended with MDI day Double potency of standard BDP Step 2 Qvar easi- Beclometasone 100 micrograms Two puffs Alternative breathe® twice daily ICS only Double potency of standard BDP Montelukast 10mgs One ADD Montelukast Tablet Review 6-8 weeks & stop if not effective at night Approved by Sunderland CCG Medicines Optimisation and Guidelines Group 19.6.18 Review date June 2020. Version 2 19.12.18 Page 1 of 4 Formulary Brand name Drug Image Dose Choice Beclometasone/Formoterol 100micrograms / 6micrograms st Fostair® fine particle MDI or NEXThaler One puff 1 choice ICS/ LABA twice a day Spacer devices recommended with MDI 2.5X more potent than standard BDP DuoResp One puff Spiromax® Budesonide/Formoterol 2nd choice twice a ICS/LABA 160micrograms / 45micrograms day Fluticasone/formoterol 125 micrograms/5 micrograms Two puffs Flutiform® Step 3 twice a Alternative ICS/LABA 2.5X more potent than standard BDP Spacer devices recommended with MDI day Not licensed for MART Regime Symbicort® Budesonide/formoterol Two puffs turbohaler 100micrograms /6micrograms twice a Alternative ICS/LABA day Equivalent to BDP Fluticasone furoate/vilanterol One puff Relvar® Ellipta 92micrograms / 22micrograms once a Alternative ICS/LABA Lack of comparable BDP equivalent day dose AND Montelukast 10mgs at night add on if necessary. Refer for specialist advice if concerned Beclometasone/Formoterol 100micrograms/6micrograms Fostair® fine particle MDI st One puff 1 Choice MART dosing twice a day ICS/LABA Maximum 8 puffs in 24 hours Spacer devices recommended with MDI 2.5X more potent than standard BDP Budesonide/formoterol 160micrograms / 4.5micrograms DuoResp® nd One puff 2 choice Spiromax Equivalent to BDP twice a day Step 4 ICS/LABA MART dosing MART regimen Maximum 12 puffs in 24 hours Budesonide/formoterol Two puffs Symbicort® 100 micrograms/6micrograms twice a day Alternative ICS/LABA plus when SMART up to 8 doses per day required Equivalent to BDP AND Montelukast 10mgs at night add on if necessary. Refer for specialist advice if concerned Approved by Sunderland CCG Medicines Optimisation and Guidelines Group 19.6.18 Review date June 2020. Version 2 19.12.18 Page 2 of 4 Formulary Brand name Drug Image Dose Choice Beclometasone/ Formoterol fine particle MDI or NEXThaler Fostair® Two puffs st 100micrograms / 6micrograms 1 choice MART MDI only twice a ICS/LABA day Spacer devices recommended with MDI 2.5X more potent than standard BDP Budesonide/Formoterol Step 5 Two puffs DuoResp® 160micrograms / 4.5micrograms 2nd choice twice a ICS/LABA Moderate ICS dose MART day Equivalent to BDP Fluticasone/Formoterol 250micrograms / 10micrograms Two puffs Flutiform® Alternative twice a ICS/LABA not licensed as MART day 2.5X more potent than standard BDP Spacer devices recommended with MDI Budesonide/Formoterol 200 micrograms/6 micrograms Symbicort® Two puffs Alternative turbohaler twice a OR ICS/LABA Equivalent to BDP day SMART Fluticasone furoate/Vilanterol Relvar Ellipta® 184 micrograms/22 micrograms One puff Alternative once a day ICS/LABA Lack of a comparable BDP equivalent dose Montelukast 10mgs at night add on if necessary. Refer for specialist advice if concerned Beclometasone/ formoterol 200 micrograms/6 micrograms fine particle MDI or NEXThaler Two puffs st Fostair® 1 choice twice a ICS/LABA MART MDI only day Spacer devices recommended with MDI 2.5X more potent than standard BDP Budesonide/Formoterol 320micrograms Two puffs nd DuoResp® / 9micrograms 2 choice twice a ICS/LABA day Equivalent to BDP Budesonide/Formoterol 200micrograms Two puffs Step 6 Symbicort® / 6micrograms Alternative twice a HIGH ICS doseHIGH ICS/LABA SMART day Equivalent to BDP Tiotropium 2.5micrograms Two puffs Spiriva® Add once a Respimat Can be used with aerochamber plus day Theophylline 200mg Every 12 Add Uniphyllin® May be titrated to 300mg / 400mg hours Specialist initiation only. Links for patients: www.mylungsmylife.org; British Lung Foundation Breathe Easy groups: www.blf.org.uk/support-for-you/breathe-easy Approved by Sunderland CCG Medicines Optimisation and Guidelines Group 19.6.18 Review date June 2020. Version 2 19.12.18 Page 3 of 4 .
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