Formulary
When prescribing inhalers the drug, device (e.g. MDI, Easibreathe, Autohaler, Accuhaler), strength (micrograms per inhalation), number of puffs per dose and frequency MUST be specified
In patients with COPD it is now recommended that long acting muscarinic antagonist SHOULD only be prescribed with a long-acting beta2 agonists (if no asthmatic features) REF NICE NG 115, GOLD 2023
| Ipratropium |
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Formulary
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Nebuliser solution 250micrograms/1mL, 500micrograms/2mL |
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| Glycopyrronium Seebri breezhaler® |
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Formulary
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Hard capsule 44 micrograms per inhalation with Seebri Breezhaler® device |
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| Tiotropium |
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Formulary
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COPD Spiriva 18 microgram inhalation powder, hard capsule, Spiriva Respimat 2.5 microgram, inhalation solution, Tiotropium (Braltus) 10mcg Inhalation Powder Prescribe by brand |
 MHRA: Braltus (tiotropium): risk of inhalation of capsule if placed in the mouthpiece of the inhaler MHRA: Tiotropium delivered via Respimat compared with Handihaler: no significant difference in mortality in TIOSPIR trial |
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| Tiotropium |
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Formulary
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Asthma Spiriva Respimat 2.5 microgram, inhalation solution Only Respimat® device is licensed for asthma |
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MHRA Drug Safety Update May 2018: Braltus (tiotropium): risk of inhalation of capsule if placed in the mouthpiece of the inhaler |
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Links
- NICE TA10: Guidance on the use of inhaler systems (devices) in children under the age of 5 years with chronic asthma
Asthma action plan child: Asthma UK- Asthma management plan: Asthma UK
- LSCMMG: Asthma Treatment Guideline for Adults
- LSCMMG: Asthma Treatment Guideline for Children
- LSCMMG: Chronic Obstructive Pulmonary Disease (COPD) Desktop Guideline
- MART asthma plan
- MHRA Drug Safety Update :Nebulised asthma rescue therapy in children: home use of nebulisers in paediatric asthma should be initiated and managed only by specialists
- MHRA Drug Safety Update May 2018: Braltus (tiotropium): risk of inhalation of capsule if placed in the mouthpiece of the inhaler
- MHRA: Braltus (tiotropium): risk of inhalation of capsule if placed in the mouthpiece of the inhaler
- MHRA: Pressurised metered dose inhalers (pMDI): risk of airway obstruction from aspiration of loose objects
- MHRA: Tiotropium delivered via Respimat compared with Handihaler: no significant difference in mortality in TIOSPIR trial
- NICE NG115: Chronic obstructive pulmonary disease in over 16s: diagnosis and management
- NICE NG209: Tobacco: preventing uptake, promoting quitting and treating dependence
- NICE NG80:Asthma: diagnosis, monitoring and chronic asthma management
- NICE TA347: Nintedanib for previously treated locally advanced, metastatic, or locally recurrent non‑small‑cell lung cancer
- NICE TA38: Inhaler devices for routine treatment of chronic asthma in older children (aged 5–15 years)