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Guidance on inhaler devices and Nebulised therapy

First line drugs Second line drugs Specialist drugs Secondary care drugs

 

Short acting beta2 agonists (SAB2A)

Long acting beta2 agonists (LAB2A)

Inhaled corticosteroids (ICS)

Combination LAB2A & ICS

MDI (ideally used with spacer)

Salbutamol

Formoterol

Clenil Modulite (Beclometasone),  Fluticasone -(from step 3)

Fostair (Beclometasone / Formoterol) -1st line combo          Seretide

Easyhaler (DPI)

 Salbutamol

 Formoterol

Budesonide

 No combo available

Turbohaler (DPI)

Terbutaline

  Formoterol

Budesonide

Symbicort

 Novoliser (DPI)

 Salbutamol

 No LABA available

 Budesonide

No combo available

Accuhaler (DPI)

 Salbutamol

Salmeterol

Fluticasone

Seretide

 

 

 

 

 

 

Short-acting Antimuscarinic bronchodilator

Long-acting Antimuscarinic bronchodilator

 

 

MDI (ideally used with spacer)

Ipratropium bromide 

 

 

 

Handihaler (DPI)

 

Tiotropium

 

 

Respimat

 

Tiotropium

 

 

 Genuair (DPI)

 

 Aclidinium?

 

 

 Breezhaler

 

 Glycopyrronium?

 

 

MDI - Metered Dose Inhaler (Slow & steady breath)

DPI - Dry Powder Inhaler (Deep & forceful breath)

Respimat & Breezhaler - (Slow & steady breath)

Genuair (Deep & forceful breath)

Notes:    

 

  • There is no MDI preparation of inhaled corticosteroid and long acting bronchodilator licensed for use in COPD. Experience shows that with instruction most elderly patients can manage any type of inhaler. Off licence use of Seretide 250 MDI in COPD is only justified if effective use of the licensed dry powder inhalers cannot be shown, but note this is extremely expensive.
  • Adding a spacer may improve concordance and improves deposition leading to a reduced absorption of steroids from the mouth and gastrointestinal tract. Therefore a spacer should always be prescribed for children and adults requiring medium to high doses of steroids. Many people are unable to use an MDI without a spacer.
  • Where a patient cannot use, or concordance is poor with an MDI + spacer the patient should try a variety of devices and choose one that they have shown that they can use effectively, even when breathless.
  • The patients understanding of their inhaler regime and their inhaler technique should be checked frequently until established and then at each review.

 

 

Nebulised Therapy

General

  • Before considering nebulised bronchodilators confirm optimal treatment with bronchodilators, good inhaler technique and consider other treatment options eg. in COPD, theophyllines and pulmonary rehabilitation.
  • In adult asthma patients the requirement for regular nebulised bronchodilators would be an indication for referral.

Children

  • Children requiring long-term nebulised therapy should be under the care of a consultant paediatrician.
  • The provision of a home nebuliser for the management of acute asthmatic attacks is generally not recommended in children.
  • The use of a nebuliser in acute asthmatic attacks in children under 2 years of age may result in a marked deterioration. Large volume spacers are preferable to nebulisers, where available. If it is felt appropriate to use a nebuliser in primary care, please be cautious.

 

 3.1.5 Peak flow meters, inhaler devices and nebulisers   

 

Return to Chapter: 3. Respiratory System

Last updated by: on 05-10-2016 14:24