Specialist initiation for severe brittle asthma/ cystic fibrosis

• Soltel® is a less expensive brand for patients >12 years of age N.B. Soltel® is contraindicated in patients with peanut or soya allergy
• Prescribe by brand to ensure patients receive the device they are used to.
• Check licensed indication (differences among brands).
• Be aware of differences in excipients among the different brands.

• For COPD only

• Spiriva Respimat® is the preferred device for tiotropium prescribing
• Braltus® is a less expensive option than tiotropium Handihaler® (non-formulary) only for existing patients on Handihaler® and should not be initiated for new patients.

  For asthma - maintenance bronchodilator in line with NICE guidance

  For COPD

• For COPD.
• Approved on formulary February 2017

All spacer devices

• Soprobec^® is a less expensive brand of beclometasone dipropionate than Clenil Modulite^®
• Kelhale^® is a less expensive brand for prescribing beclometasone dipropionate as extra fine particles in patients >18 years of age. 

Kelhale^® has extra-fine particles, is equivalent to Qvar^® (non-formulary), is more potent than traditional beclometasone dipropionate CFC-containing inhalers and is approximately twice as potent as Soprobec^®  and Clenil Modulite^®. Kelhale^® should only be prescribed for existing Qvar^® patients >18 years of age and not initiated for new patients.

May 2020 - see Clenil® Modulite® 100mcg (beclometasone): release of batch specific variation

For paediatric use ONLY (i.e. up to 18 years of age)

  Fluticasone Evohaler 50, Fluticasone Accuhaler 50,100

   Fluticasone Evohaler 125, Fluticasone Accuhaler 250

• Initiation by a respiratory specialist
• Supported by a RICaD

• Combisal® 25/50 and 25/125 metered dose inhaler
• Sereflo® 25/250 metered dose inhaler
• Stalpex® 50/500 dry powder inhaler

Combisal® is a less expensive brand for prescribing salmeterol and fluticasone 25/50 and 25/125 strengths than Seretide Evohaler®. Sereflo® is a less expensive brand for prescribing salmeterol and fluticasone 25/250 strength than Seretide Evohaler®.

Stalpex® 50/500 is a less expensive brand for prescribing salmeterol and fluticasone 50/500 than Seretide Accuhaler®.

For paediatric use ONLY (i.e. up to 18 years of age)

• Seretide Evohalers
• Seretide Accuhalers
• Should be prescribed by the intended brand to ensure patients are maintained on the formulation they are used to.
• When reviewing patients on Seretide 250 Accuhaler,consider switch to Fostair or Flutiform if appropriate.

• For COPD- 92mcg/22mcg
• For asthma- both strengths

COPD Appendix 4 - Criteria for triple therapy and for triple inhaler use in COPD

COPD Appendix 4 : Criteria for triple therapy and for triple inhaler use in COPD

In line with NICE
Specialist initiation- transfer of prescribing supported by RICaD

RICaD: Roflumilast for treating COPD

OTC preparation suitable for self-care/purchase if appropriate

OTC preparation suitable for self-care/purchase if appropriate

• Tablets
• Syrup

OTC preparation suitable for self-care/purchase if appropriate

Second line- in children as per guidance

• Supported by RICaD
  RICaD: Grazax

There are currently supply issues with adrenaline autoinjectors (October 2018-on) - See anaphylaxis UK advice

Injection technique is device specific. To ensure patients receive the auto-injector device that they have been trained to use, prescribers should prescribe by brand.

Injection technique is device specific. To ensure patients receive the auto-injector device that they have been trained to use, prescribers should prescribe by brand.

Injection technique is device specific. To ensure patients receive the auto-injector device that they have been trained to use, prescribers should prescribe by brand.

Hospital only- NHSE commissioned

Hospital only- NHSE Commissioned

Use in line with NICE

Highly specialist allergy centre- NHSE commissioned

  Short term use in palliative care
 
  Long term use- requires specialist assessment

Hospital Only

• Tablets
• Sachets- available as 200mg powder for oral solution- licensed product.
• Effervescent tablets

In line with NICE

Commissioned by NHS England for Cystic Fibrosis only

  New patients
 
  For existing patients (initiated pre April 2013)

Over the counter preparation suitable for self-care/purchase if appropriate

Palliative care only

Over the counter preparation suitable for self-care/purchase if appropriate

Over the counter preparation suitable for self-care/purchase if appropriate

Over the counter preparation suitable for self-care/purchase if appropriate 

Hospital only - NHSE commissioned

• in conjunction with prednisolone (plain tablets, not EC)
• Supported by ESCA , see link below.

• Supported by ESCA , see link below.
• 2.5mg tablets 

• Plain tablets (not enteric coated)

Commissioned by NHS England for Cystic Fibrosis only

  New patients
 
   Existing patients (initiated prior to April 2013)

Commissioned by NHS England for Cystic Fibrosis only.

  New patients
 
  Existing patients (initiated prior to April 2013)

In line with NICE

In line with NHSE

• For specialist use only in line with NICE guidance below
• NHS England is the responsible commissioner for use in Asthma
• Clinical Commissioning Groups are the responsible commissioners for use in urticaria

• For specialist use only in line with NICE
• NHS England is the responsible commissioner for use in Asthma

In line with NICE