3.0 Respiratory System

General Advice

• Asthma – useful resources:
  • ‘British Guideline on the Management of Asthma’ produced by the British Thoracic Society (BTS) and SIGN 2019
  • Global Initiative for Asthma (GINA) 2023
  • NICE NG80 Asthma: diagnosis, monitoring and chronic asthma management, 2017 (NICE/BTS/SIGN joint guideline for the diagnosis, monitoring and management of chronic asthma is anticipated to be published in July 2024)
  • PrescQIPP bulletin 251 Asthma, 2020
• COPD – useful resources:
  • Global Initiative for Chronic Obstructive Lung Disease (GOLD) website 2024
  • PrescQIPP Bulletin 283 COPD 2022
  • NICE Clinical Guideline Chronic obstructive pulmonary disease in over 16s: diagnosis and management NG115 2018
  • COPD acute exacerbations – see NI Primary Care Antimicrobial Guidelines
• Choice of device should be considered on basis of ability to use the inhaler, patient-acceptability, carbon footprint and cost. Check medication adherence and inhaler technique before each step up of treatment in asthma and at each review / every opportunity.
• Aim to minimise the range of inhaler types the patient needs to master. Where possible prescribe the same type of inhaler device to deliver preventer and reliever treatments.
• It is essential to specify inhaler device, strength and dose. Many inhaler devices including dry powder inhalers and those containing beclometasone (+ /- formoterol) are not suitable for generic prescribing.
• Written personalised action plans as part of self-management education have been shown to improve health outcomes for people with asthma. Personalised asthma and COPD action plans are available from Asthma + Lung UK. Patients should talk through the plan with their healthcare professional and fill it in together so it is personal to them.
• Prescribe inhalers only after patients have been trained in their use and demonstrated satisfactory technique. Asthma + Lung UK have useful videos and information for patients on ‘using your inhalers’. RightBreathe provides useful information on all UK licensed inhalers and spacers.
• To reduce the carbon footprint of inhaler prescribing:
  • Optimise asthma and COPD care following national guidelines
  • Offer Dry Powder Inhalers (DPIs) or soft mist inhalers as first choice when clinically appropriate
  • If Metered Dose Inhalers (MDIs) are needed then choose a brand and regime to minimise carbon footprint –resources to support inhaler choice can be found here
  • Change to combination inhalers where clinically appropriate
  • Ask patients to return all used or unwanted inhalers to community pharmacies for disposal
  • A Patient decision aid (PDA) on asthma inhalers and climate change is available from NICE