![]() Incruse Ellipta once daily at the same time of the day each day. The recommended dose in adults (also the maximum dose) is one inhalation of At six months, the patient will once again receive one inhaler plus one cartridge. Patients prescribed Respimat inhalers will now receive one inhaler plus one cartridge for their initial prescription, followed by packs containing one refill cartridge. The soft-mist inhalers Spiriva Respimat (tiotropium), Striverdi Respimat (olodaterol) and Spiolto Respimat (olodaterol/tiotropium) can now be reused with up to six refill cartridges rather than disposed of as soon as a single cartridge is finished. Tiotropium Spiriva Respimat®(soft-mist inhaler) was included in the formulary for patient choice £19.99 (30 inhalation capsules + inhaler) Tiotropium should not be combined with ipratropium due to increased risk of anticholinergic side-effects If no benefit after trial period, stop treatment. May be used in asthma as an alternative to increasing ICS dose. Use in COPD should be in line with the local COPD guidance, which is consistent with the NICE guidance, see here for more information. Tiotropium is licensed for use in COPD and asthma. The dose isĮach 50 microgram capsule delivers a dose of 44 micrograms of glycopyrroniumīraltus Zonda® delivers 10mcg tiotropium to the lungs and is dose equivalent to the 18mcg tiotropium Handyhaler. Glycopyrronium is licensed for the maintenance treatment of COPD. Each 400 mcg metered inhalation of aclidinium bromide delivers 322 mcg of The device may be suitable for some patients who are unable to use ![]() It has been approved by the SMCĭo not co-prescribe Ipratropium with Tiotropium because of risk of increasedĪclidinium is licensed for the maintenance treatment of COPD. This is a cost neutral alternative to established treatments and may be appropriate for patients for whom once-daily administration is appropriate, especially those not requiring inhaled corticosteroids. Indacaterol is indicated for maintenance bronchodilator treatment of airflow obstruction in adult patients with COPD. Avoid in patients with nut allergy as contains lecithin.Īccuhaler licensed from 4 years as is Serevent MDI inhaler. Salmeterol is the second line LABA to formoterol MDI version licensed for over age of 12 years ![]() 12mg and 6mg strengths cost the same so use 1x 12mcg bd rather than 2圆mcg bd. It costs 2-4 times per dose more than an Easyhaler. Turbohaler formulation is second line Formoterol option. Maintenance dose is 12mcg once or twice daily. In COPD, LABAs should be used in line with the local COPD guidance If no benefit after trial period, stop treatmentįormoterol is the first line LABA as Easyhaler. Consider stopping LABAs in well-controlled patients once inhaled corticosteroid dose has been reduced ( See step-down guidance) ![]() LABA should only be started in patients who are already on inhaled corticosteroids, and the inhaled corticosteroid should be continued. In asthma LABAs should only be added if regular use of a standard dose ICS has failed to control asthma adequately and should be discontinued if there is no response to treatment. Low volume puffs may be beneficial for many patients as they may have a better user technique Salamol or Airomir are preferred pMDI as it is low volume HFC which is environmentally more beneficial than large volume such as Ventolin or other generic brands. Salbutamol Easyhaler has an integrated dose counter unlike salbutamol pMDIs If patient is on a LABA/ICS dry powder device, consider a DPI reliever also. In Somerset 1 in 5 patients are prescribed 6+ SABA inhalers in a 12 month period.ĬOPD patients will benefit from dual bronchodilation with long acting LABA/LAMA combination rather than SABA ad hoc.Įnsure that patients have same types of device, avoiding mixtures of pMDIs and DPIs. Poor inhaler technique and compliance issues with preventer medication are often the cause. Asthma: treatment during pregnancy (SPS January 2022)Īsthma: diagnosis, monitoring and chronic asthma management NICE guideline (November 2017, updated March 2021)Ĭhronic obstructive pulmonary disease in over 16s: diagnosis and management NICE guideline (NG115 December 2018 updated July 2019) Therapeutic AreaĪ salbutamol inhaler contains 25 days supply at full dose (8 puffs/day).Īsthmatic patients who are reliant on their SABA inhaler >3 times a week are poorly controlled and should be reviewed. ![]()
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