Short-Acting beta2 Agonist Bronchodilators (SABAs)

Preferred list (P)

SALBUTAMOL

  • Salbutamol is first-line due to costs.
Carbon footprint* Brand  Inhaler type
High Generic prescribing pMDI
Low Easyhaler Salbutamol®, Ventolin® Accuhaler® DPI (dry powder inhaler)

*Low (<35 g CO2e) or High (≥35 g CO2e) carbon footprint per puff

Reference:PrescQIPP Bulletin 295 [Accessed 28.4.23]

 

Total list (T)

TERBUTALINE

Carbon footprint* Brand Inhaler type
Low Bricanyl®Turbohaler® DPI 

*Low (<35 g CO2e) or High (≥35 g CO2e) carbon footprint per puff

Reference:PrescQIPP Bulletin 295 [Accessed 28.4.23]

Long-Acting beta2 Agonist Bronchodilators (LABAs)

Preferred list (P)

SALMETEROL

FORMOTEROL

Prescribing Notes:

  • Due to the increased mortality risk it is important that LABAs are used alongside inhaled corticosteroids for patients with asthma.

Long-Acting Muscarinic Antagonist Bronchodilators (LAMAs)

Preferred list (P)

TIOTROPIUM DRY POWDER (Tiogiva®)

TIOTROPIUM SOLUTION FOR INHALATION (Spiriva Respimat®)

UMECLIDINIUM (Incruse Ellipta®)

Carbon footprint* Brand Inhaler type
Low Tiogiva® DPI 
Low Spiriva Respimat® SMI (soft mist inhaler) 
Low Incruse Ellipta® DPI

*Low (<35 g CO2e) or High (≥35 g CO2e) carbon footprint per puff

Reference:PrescQIPP Bulletin 295 [Accessed 28.4.23]

 

Total list (T)

GLYCOPYRRONIUM (Seebri Breezhaler®)

ACLIDINIUM (Eklira Genuair®)

Carbon footprint* Brand Inhaler type
Low Seebri Breezhaler® DPI
Low Eklira Genuair® DPI

*Low (<35 g CO2e) or High (≥35 g CO2e) carbon footprint per puff

Reference:PrescQIPP Bulletin 295 [Accessed 28.4.23]

Prescribing Notes:

  • Monotherapy with LAMAs for COPD is no longer routinely recommended in NHS Lanarkshire; however existing patients whose symptoms are under control can continue on their current treatment until it is appropriate for them to change.
  • Use of LAMA monotherapy may be required where combination inhalers are not tolerated or contraindicated.
  • Inhalers should be prescribed by brand name.
  • For further advice on the treatment of COPD and dosing regimens please see the NHSL Guidelines for the Pharmacological Management of COPD.

Theophylline

Preferred list (P)

THEOPHYLLINE (Uniphyllin Continus®)

  • Please note - aminophylline preparations Phyllocontin® Continus 225mg and Phyllocontin® Forte Continus 350mg tablets have been discontinued (MHRA Central Alerting System Feb 2021).
  • See below for advice on further management of patients currently prescribed Phyllocontin® products.
  • Prescribing by brand is recommended for oral formulations due to variations in bioavailability.

Prescribing Notes:

  • Intravenous aminophylline is not a recommended drug in primary care having been superseded by nebulised beta2–agonists.
  • Theophylline has a narrow margin between therapeutic and toxic effects; therapy should be monitored. For information relating to interactions see BNF for details.

Discontinuation of aminophylline (Phyllocontin®) tablets

NHS Lanarkshire Respiratory Team advice (February 2021):

  • Patients with good control (ACT>20 / CAT <10 and no exacerbations in the last year) can be offered discontinuation of treatment with aminophylline and if they deteriorate, theophylline (Uniphyllin Continus®) can be initiated.
  • Patients who are uncontrolled (symptomatic, exacerbation in the last year) should be switched to theophylline (Uniphyllin Continus®).
  • Patients stabilised on aminophylline 225mg twice a day who require a switch to low dose theophylline will not require blood level monitoring unless there are concerns around signs and symptoms of toxicity.
  • Patients on higher doses of aminophylline (> 225mg twice a day), or medications that can affect blood levels, or currently have active level monitoring, will require blood level monitoring if switched to theophylline.
  • Recommended blood monitoring on initiation of theophylline when required:
    • Plasma-theophylline concentration should be measured 5 days after starting oral treatment and at least 3 days after any dose adjustment.
    • A blood sample should usually be taken 4–6 hours after an oral dose of a modified-release preparation.

Combination Bronchodilator Preparations for COPD: LAMA With LABA

Preferred list (P)

TIOTROPIUM WITH OLODATEROL (Spiolto Respimat®)

UMECLIDINIUM WITH VILANTEROL (Anoro Ellipta®)

Carbon footprint* Brand Inhaler type
Low  Spiolto Respimat® SMI
Low Anoro Ellipta® DPI

*Low (<35 g CO2e) or High (≥35 g CO2e) carbon footprint per puff

Reference:PrescQIPP Bulletin 295 [Accessed 28.4.23]

 

Total list (T)

GLYCOPYRRONIUM WITH INDACATEROL (Ultibro Breezhaler®)

ACLIDINIUM WITH FORMOTEROL (Duaklir Genuair®)

Carbon footprint* Brand Inhaler type
Low Ultibro Breezhaler® DPI
Low Duaklir Genuair® DPI 

*Low (<35 g CO2e) or High (≥35 g CO2e) carbon footprint per puff

Reference:PrescQIPP Bulletin 295 [Accessed 28.4.23]

Prescribing Notes:

 

NHSL Joint Adult Formulary Key

To indicate the category of a formulary medicine, updated sections adopt the following key:

Preferred list (P): First-line formulary choices.

Total list (T): Alternative choices when preferred list options not effective/not tolerated, or not indicated.

Specialist initiation (S1): Specialist initiation, or on the advice of a Consultant or Specialist Practitioner in this therapeutic area. Continuation in primary care is acceptable.

Specialist use only (S2): Supply via hospital, Homecare Service or a hospital based prescription (HBP) for dispensing by community pharmacy. Not prescribed in primary care setting.

Editorial Information

Last reviewed: 31/01/2022

Next review date: 31/01/2025

Author(s): NHSL.

Version: Please refer to the introduction section for an explanation of the review dates above.

Approved By: ADTC

Reviewer name(s): ADTC.