3.2.1 Single agent inhalers [asthma only]

Prescribe an inhaler with a lower carbon impact where possible – resources can be found here.

Prescribing Notes

• Offer Dry Powder Inhalers (DPIs) as first choice when clinically appropriate.
• If prescribing a beclometasone MDI, the MHRA recommends prescribing by brand name to ensure the patient receives the correct dose and preparation. Clenil Modulite^® is first choice where a MDI is required.
• When considering doses, beclometasone dipropionate (except Qvar^®) and budesonide are equipotent and fluticasone propionate is twice as potent (see BTS guidelines).
• Spacer devices should be prescribed for patients receiving high dose steroids.
• A corticosteroid safety card and accompanying patient information leaflets should be given to patients on high doses of inhaled steroids (more than 1000micrograms/day of beclometasone dipropionate or equivalent).
• An additional Steroid Emergency Card for Northern Ireland has been developed in response to the National Patient Safety Alert that was issued in August 2020. The alert highlights the dangers associated with adrenal insufficiency for patients taking corticosteroid medication, and recommends that all eligible patients prescribed (or initiated on) steroids are assessed and where necessary issued with a Steroid Emergency Card. Community pharmacies and GP practices can order these from pharmacystationeryorders@hscni.net
• In adults, doubling the dose of inhaled steroids at the time of an exacerbation of asthma has not been shown to be effective and is therefore not recommended.
• The dose should be titrated to the lowest dose at which effective control of asthma is maintained.