3.1.1 Adrenoreceptor agonists | 3.1.1.1 Selective beta2-agonists | | GREEN Salbutamol | |
metered dose inhaler (MDI) 100micrograms/inhalation |
breath-actuated inhaler 100 microgram/inhalation (Airomir Autohaler®) |
breath actuated dry powder inhaler 100mcg/inhalation (Easyhaler® Salbutamol ) |
breath actuated dry powder inhaler 200mcg/inhalation (Easyhaler® Salbutamol ) |
dry powder inhaler 200 microgram/blister (Ventolin Accuhaler®) |
nebuliser solution 2.5mg/2.5ml, 5mg/2.5mL |
syrup 2mg/5mL |
|
RED Salbutamol |
injection 500 microgram/mL |
solution for intravenous infusion 5mg/5mL |
GREEN Terbutaline |
dry powder inhaler 500 microgram/inhalation (Bricanyl Turbohaler®) |
nebules 5mg/2mL |
|
Longer acting beta 2 - agonists |
Use regularly in addition to inhaled corticosteroids and inhaled bronchodilators for improved control as described in Step 3 |
of BTS guidelines. Comparative costs for longer acting beta2 - adrenoceptor stimulants are indicated. |
|
Formoterol |
Formoterol should only be used in accordance with national and local guidance on the management of asthma or COPD. |
In asthma it should not be used as monotherapy, but be used alongside inhaled corticosteroids as per MHRA advice. |
Formoterol metered dose inhaler (MDI) presented as the brand Easyhaler® is the first line long acting beta-2 agonist of |
choice within Peninne Lancashire. |
GREEN Formoterol |
dry powder for inhaler 12 microgram/inhalation (Easyhaler Formoterol ®) |
GREEN Formoterol |
dry powder inhaler 6 microgram/metered inhalation (Oxis Turbohaler®) |
dry powder inhaler 12 microgram/metered inhalation (Oxis Turbohaler®) |
|
Salmeterol |
Second line option |
GREEN Salmeterol |
metered dose inhaler (MDI) 25 microgram/inhalation (Serevent®) |
dry powder inhaler 50 microgram/blister (Serevent Accuhaler®) |
|
Indacaterol |
Third line option for patients with moderate COPD who are having difficulties with either compliance or the inhaler device. |
GREEN Indacaterol |
dry powder hard capsule 150, 300 microgram (Onbrez Breezhaler®) |
Note minimum inspiratory flow rate required 50L/min |
|
Beclomethasone dipropionate/formoterol fumarate dihydrate/glycopyrronium bromide [Trimbow®] |
For maintenance treatment of asthma, in adults not adequately controlled with a maintenance combination of a |
long-acting beta-2 agonist plus a medium dose of inhaled corticosteroid, and who had one or more exacerbations |
(flare-ups) in the past year. |
GREEN restricted use Beclomethasone dipropionate/formoterol fumarate dihydrate/glycopyrronium bromide 87/5/9 pMDI
|
[Trimbow®] |
3.1.2 Antimuscarinic bronchdilators |
For relieving bronchoconstriction in COPD as an alternative to beta2 -agonists. Ipratropium is a short acting muscarinic |
antagonist whilst Tiotropium is long acting. Tiotropium is an option at step 2 of the local guidelines in those patients with |
persistent exacebations/breathlesness. |
GREEN Ipratropium bromide |
metered dose inhaler (MDI) 20micrograms/inhalation |
nebuliser solution 250micrograms/mL |
GREEN Tiotropium inhaler (Braltus® Zonda inhaler) |
(Braltus 10 microgram per delivered dose inhalation powder, hard capsule) |
Add on maintenance bronchodilator treatment to relieve symptoms in adult patients with chronic obstructive pulmonary |
disease (COPD) |
Note: Ipratropium should be discontinued when tiotropium is introduced. |
GREEN Tiotropium Spiriva® Respimat ®▼ |
N.B. Braltus is the preferred Tiotropium product.The Tiotropium Respimat is restricted for use in COPD patients to those who |
have poor manual dexterity and difficulty using the Handihaler® |
|
Add on maintenance bronchodilator treatment in adult patients with Asthma who meet all of the following criteria: |
> persistent airflow limitation demonstrated by an FEV¹ <80% predicted and a ratio of FEV¹/FVC <70% and |
> currently treated with the maintenance combination of inhaled corticosteroids (>800 micrograms budesonide/day or |
equivalent*) and long acting ß² agonists and |
> experienced one or more severe exacerbations in the previous year. |
|
Second line ONLY where Tiotropium is not appropriate, not tolerated or there is difficulty using the device. |
Glycopyrronium bromide inhaler is available in a new device which requires lower inspiratory rate and enables visual |
compliance. |
GREEN Glycopyrronium bromide, inhaler (Seebri Breezhaler®) |
|
3rd line ONLY where Tiotropium is not tolerated or there is difficulty using the device. |
GREEN Aclidinium bromide, inhalation powder (Eklira Genuair®▼) |
3rd line option when Tiotropium is not tolerated or the device cannot be used effectively |
|
Long acting Antimuscarinic bronchodilators in combination with Long-Acting Beta² agonists (LAMA/LABA) |
GREEN Tiotropium and olodaterol |
(Spiolto® Respimat 2.5 microgram/2.5 microgram, inhalation solution) |
|
Spiolto® Respimat is indicated as a maintenance bronchodilator treatment to relieve symptoms in adult patients with |
chronic obstructive pulmonary disease (COPD). |
GREEN Glycopyrronium bromide 85mcg/Indacterol maleate 43mcg inhalation powder |
capsule device. (Ultibro®Breezhaler dry powder inhaler) |
GREEN Aclidinium and fomoterol |
(Duaklir® Genuair 340 micrograms /12 micrograms inhalation powder) |
GREEN Glycopyrronium bromide 9 µg equivalent to 7.2 µg of glycopyrronium, and 5 µg of formoterol fumarate |
dihydrate mdi |
(Bevespi Aerosphere mdi) |
|
Duaklir Genuair is indicated as a maintenance bronchodilator treatment to relieve symptoms in adult patients with chronic |
obstructive pulmonary disease (COPD) |
|
Bevespi Aerosphere is indicated as a maintenance bronchodilator treatment to relieve symptoms in adult patients with |
chronic obstructive pulmonary disease (COPD). |
|
|
Triple combination inhaler [ICS + LAMA + LABA] |
Trimbow® inhaler - link to guideline |
First line use in Patient Group D, where patient requires Triple Therapy (LAMA+LABA+ICS) (single combination inhaler, |
dose 2puffs bd). |
(Use reserved for patients who have failed to achieve or maintain an adequate response to an appropriate course of dual |
GREEN [restricted use] |
Beclomethasone 87mcg, formoterol fumarate 5mcg, glycopyrronium bromide 9mcg |
(Trimbow®pMDI) (dose = 2 puffs twice daily) |
GREEN [restricted use] |
Beclomethasone 87mcg, formoterol fumarate 5mcg, glycopyrronium bromide 9mcg |
(Trimbow® NEXThaler) (dose = 2 puffs twice daily) |
|
Trixeo Aerosphere 5mcg/7.2mcg/160mcg pressurised inhalation, suspension |
Maintenance treatment in adult patients with moderate to severe chronic obstructive pulmonary disease (COPD) who are |
not adequately treated by a combination of an inhaled corticosteroid and a long-acting beta2-agonist or combination of a |
long-acting beta2-agonist and a long-acting muscarinic antagonist. |
The intended place in therapy for the Trixeo Aeropshere is in line with the 2019 NICE Guidelines for the treatment of |
patients with moderate to severe COPD for whom a MDI is considered clinically appropriate and who experience a severe |
exacerbation (requiring hospitalisation) or two moderate exacerbations within a year whilst receiving ICS/LABA or |
LAMA/LABA. |
|
GREEN RESTRICTED 5μg formoterol fumarate dihydrate, glycopyrronium bromide 9μg, equivalent to 7.2μg of |
glycopyrronium, and budesonide 160μg |
Trixeo Aerosphere (dose = 2 puffs twice daily) |
|
3.1.3 Theophylline |
Used for reversible airways obstruction. Narrow margin between therapeutic and toxic dose. |
Prescribe oral preparations by brand name. |
|
GREEN Theophylline (Uniphyllin®) tablets m/r 200mg, 300mg, 400 mg |
|
Other preparations |
AMBER Aminophylline tablets 225mg, 350mg |
RED Aminophylline injection 25mg/ml, 10mL ampoule |
RED Caffeine citrate oral solution 50mg/5mL (unlicensed) |
RED Caffeine citrate intravenous injection 10mg/2mL (NICU only) (unlicensed) |
Note: caffeine 10mg = caffeine citrate 20mg. |
To avoid confusion these preparations must always be prescribed as CAFFEINE CITRATE. |