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
  • NICE NG80 Asthma: diagnosis, monitoring and chronic asthma management, 2017
  • PrescQIPP ‘Asthma’ bulletin, 2020
• COPD – useful resources:
  • PrescQIPP ‘Inhaled Therapy in COPD’ bulletin and resources. Available on PrescQIPP website
  • NICE Clinical Guideline  COPD NG115
  • Global Initiative for Chronic Obstructive Lung Disease (GOLD)
• Written personalised action plans as part of self-management education have been shown to improve health outcomes for people with asthma, where appropriate. Personalised asthma action plans are available from PHA and Asthma UK . Prescribe inhalers only after patients have been trained in their use and demonstrated satisfactory technique. Asthma UK have useful videos and information for patients on ‘using your inhalers’.
• 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. 
• 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 chose brand and regime with care to minimise carbon footprint –resources to support choice can be found here
  • Ask patients to return all used or unwanted inhalers to community pharmacies for disposal
• Changing the type of inhaler device may affect the effectiveness of therapy and the incidence of adverse effects.
• It is essential to specify inhaler device, strength and dose. Certain inhaler devices such those containing beclometasone (+/- formoterol) and dry powder inhalers are not suitable for generic prescribing.
• Not all spacers are compatible with all inhalers, refer to the BNF.
• On very rare occasions nebulised bronchodilators may be required when a patient with severe asthma or COPD is unable to use inhalers. Patients should be appropriately assessed before nebulised therapy is deemed appropriate.
• If using nebulised salbutamol, 2.5mg unit dose vials (UDVs) should generally be used, which can be repeated if required. Side effects such as tachycardia are more common with the 5mg dose, particularly in elderly patients. In emergency situations, 5mg UDVs may be required. NB –use of nebulised therapy in acute exacerbations of asthma is not covered in this formulary.