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 Formulary Chapter 3: Respiratory system - Full Chapter
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03.01  Expand sub section  Bronchodilators
03.01  Expand sub section  Asthma
03.01  Expand sub section  Chronic obstructive pulmonary disease
03.01  Expand sub section  Croup
03.01.01  Expand sub section  Adrenoceptor agonists to top
03.01.01.01  Expand sub section  Selective Beta2 agonists
Salbutamol inhaler (pMDI) and nebuliser solution
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Formulary
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Secondary care notes

  • NMUH approvals:
    • See links below
  • RFL approvals:
    • Nil
  • RNOH approvals:
    • Nil
  • UCLH approvals:
  • WH approvals:
    • Nil
 
Link  NCL JFC (Haringey, Islington and Camden only): Stable COPD Treatment Guidelines
Link  NCL JFC: Adult Asthma Inhaler Choice
   
Formoterol fumarate (Oxis® Turbohaler)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
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Secondary care notes

  • NMUH approvals:
    • Not applicable
  • RFL approvals:
    • Nil
  • RNOH approvals
    • Not applicable
  • UCLH approvals:
  • WH approvals:
    • Turbohalers, Accuhalers and Autohalers are reserved for patients unable to tolerate an MDI with spacing device.
 
   
Salbutamol IV
View adult BNF View SPC online View childrens BNF
Formulary
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Secondary care notes

  • NMUH approvals:
    • Nil
  • RFL approvals:
    • Nil
  • RNOH approvals
    • Nil
  • UCLH approvals:
  • WH approvals:
    • Nil
 
   
Salbutamol oral
View adult BNF View SPC online View childrens BNF
Formulary
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Secondary care notes

  • NMUH approvals:
    • Nil
  • RFL approvals:
    • Nil
  • RNOH approvals:
    • Not applicable
  • UCLH approvals:
  • WH approvals:
    • Nil
 
   
Salbutamol oral modified release (Ventmax® SR)
View adult BNF View SPC online View childrens BNF
Formulary

Secondary care notes

  • NMUH approvals:
    • Not applicable
  • RFL approvals:
    • Not applicable
  • RNOH approvals:
    • Not applicable
  • UCLH approvals:
  • WH approvals:
    • Not applicable
 
   
Salmeterol
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Formulary
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Secondary care notes

  • NMUH approvals:
    • See links below
  • RFL approvals:
    • Nil
  • RNOH approvals
    • Nil
  • UCLH approvals:
  • WH approvals:
    • Turbohalers, Accuhalers and Autohalers are reserved for patients unable to tolerate an MDI with spacing device.
    • Inhaler CFC-Free 25 micrograms/metered inhalation and Accuhaler 50 micrograms/ metered inhalation ONLY.
 
Link  NCL JFC (Haringey, Islington and Camden only): Stable COPD Treatment Guidelines
Link  NCL JFC: Adult Asthma Inhaler Choice
   
Terbutaline inhaler and nebuliser solution (Bricanyl® Turbohaler and Respules)
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Formulary
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Secondary care notes

  • NMUH approvals:
    • See links below
  • RFL approvals:
    • Nil
  • RNOH approvals
    • Nil
  • UCLH approvals:
  • WH approvals:
    • Nil
 
Link  NCL JFC: Asthma Prescribing Guidelines
   
Terbutaline IV
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Formulary
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Secondary care notes

  • NMUH approvals:
    • Nil
  • RFL approvals:
    • Nil
  • RNOH approvals
    • Not applicable
  • UCLH approvals:
  • WH approvals:
    • Not applicable
 
   
Terbutaline oral
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Formulary
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Secondary care notes

  • NMUH approvals:
    • Nil
  • RFL approvals:
  • RNOH approvals:
    • Not applicable
  • UCLH approvals:
  • WH approvals:
    • Not applicable
 
   
03.01.01.01  Expand sub section  Short-acting beta2 agonists
03.01.01.01  Expand sub section  Long-acting beta2 agonists
03.01.01.02  Expand sub section  Other adrenoceptor agonists
03.01.02  Expand sub section  Antimuscarinic bronchodilators to top
Ipratropium pMDI and nebuliser solution
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Formulary
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Secondary care notes

  • NMUH approvals:
    • See links below
  • RFL approvals:
    • Nil
  • RNOH approvals
    • Nil
  • UCLH approvals:
  • WH approvals:
    • CFC-free inhaler 20 micrograms/metered inhalation ONLY
 
Link  NCL JFC (Haringey, Islington and Camden only): Stable COPD Treatment Guidelines
   
Tiotropium (Braltus® Zonda)
(COPD)
View adult BNF View SPC online View childrens BNF
Formulary
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Approved for COPD (February 2017).

Braltus® Zonda is the preferred device (Braltus is labelled as 10mcg ‘delivered dose’ where Spiriva is labelled as 18mcg ‘pre-meter dose’ and both deliver the same dose).

Secondary care notes

  • NMUH approvals: 
    • See links below
    • Check MHRA Drug Safety Updates
  • RFL approvals:
    • Not applicable
  • RNOH approvals
    • Nil
  • UCLH approvals:
  • WH approvals:
    • Not applicable 
 
Link  NCL JFC (Haringey, Islington and Camden only): Stable COPD Treatment Guidelines
   
Tiotropium (Spiriva® Handihaler)
(COPD)
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Formulary
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Braltus® Zonda is the preferred device (Braltus is labelled as 10mcg ‘delivered dose’ where Spiriva is labelled as 18mcg ‘pre-meter dose’ and both deliver the same dose).

Secondary care notes

  • NMUH approvals:
    • See links below
    • Check MHRA Drug Safety Updates
  • RFL approvals:
    • Nil
  • RNOH approvals
    • Nil
  • UCLH approvals:
  • WH approvals:
    • Tiotropium were approved for prescribing by Respiratory Team only. All pharmacists must ensure inpatients have been reviewed by Respiratory Nurse Specialist before supplying prior to prescribing. 
 
Link  NCL JFC (Haringey, Islington and Camden only): Stable COPD Treatment Guidelines
   
Umeclidinium (Incruse Ellipta®)
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Formulary
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Approved for COPD (February 2017)

Secondary care notes

  • NMUH approvals:
    • Not applicable
  • RFL approvals:
    • Not applicable
  • RNOH approvals
    • Not applicable
  • UCLH approvals:
  • WH approvals:
    • Nil
 
   
Tiotropium (Spiriva Respimat®)
(Asthma)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
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Approved for severe asthma when Initiated by Severe Asthma service only (January 2016).

Secondary care notes

  • NMUH approvals:
    • Nil
  • RFL approvals:
    • As above
    • Initiation by respiratory team only
  • RNOH approvals:
    • Not applicable
  • UCLH approvals:
  • WH approvals:
    • Nil
 
   
03.01.03  Expand sub section  Theophylline
Aminophylline (Phyllocontin Continus®)
View adult BNF View SPC online View childrens BNF
Formulary
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Secondary care notes

  • NMUH approvals:
    • Nil
  • RFL approvals:
    • Nil
  • RNOH approvals
    • Nil
  • UCLH approvals:
  • WH approvals:
    • Nil
 
   
Aminophylline IV
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Formulary
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Secondary care notes

  • NMUH approvals:
    • Nil
  • RFL approvals:
    • Nil
  • RNOH approvals:
    • Nil
  • UCLH approvals:
  • WH approvals:
    • Nil
 
   
Theophylline (Nuelin® SA)
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Formulary
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Secondary care notes

  • NMUH approvals:
    • Nil
  • RFL approvals:
    • Not applicable
  • RNOH approvals
    • Nil
  • UCLH approvals:
  • WH approvals:
    • Not applicable
 
   
Theophylline (Slo-Phyllin®)
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Formulary
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Secondary care notes

  • NMUH approvals:
    • Nil
  • RFL approvals:
    • 60mg, 125mg and 250mg capsules available
  • RNOH approvals
    • Nil
  • UCLH approvals:
  • WH approvals:
    • Nil
 
   
Theophylline (Uniphyllin® Continus)
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Formulary
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Secondary care notes

  • NMUH approvals:
    • Nil
  • RFL approvals:
    • 200mg, 300mg and 400mg tablets available
  • RNOH approvals
    • Nil
  • UCLH approvals:
  • WH approvals:
    • Nil
 
   
03.01.04  Expand sub section  Compound bronchodilator preparations
Umeclidinium + Vilanterol (Anoro Ellipta®)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
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Approved for COPD who decline on or cannot tolerate inhaled corticosteroids (ICS) and have:

  • FEV1 <50% and persistent breathlessness despite PRN short-acting beta-agonist or short acting antimuscarinic (patients could be in GOLD stage C or D)
  • FEV1 ≥ 50% predicted who are experiencing exacerbations, or have breathlessness despite maintenance with LAMA, will also be considered for treatment with combination, especially if there isn’t a clear need for ICS (patients could be GOLD stage B, C or D) (July 2016, September 2016)

 

Secondary care notes

  • NMUH approvals:
    • To be prescribed by/ on the recommendation of the Respiratory Consultants.
  • RFL approvals:
    • To be prescribed by/ on the recommendation of the Respiratory Consultants
  • RNOH approvals
    • Not applicable
  • UCLH approvals:
  • WH approvals:
    • Nil
 
Link  NCL JFC (Camden, Haringey and Islington only): Stable COPD Treatment Guidelines
   
03.01.05  Expand sub section  Peak flow meters, inhaler devices and nebulisers
03.01.05  Expand sub section  Peak flow meters
Low range peak flow meter (Mini-Wright®)
View adult BNF View SPC online View childrens BNF
Formulary
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Standard range peak flow meter (Mini-Wright®)
View adult BNF View SPC online View childrens BNF
Formulary
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03.01.05  Expand sub section  Drug delivery devices to top
Spacer (AeroChamber Plus®)
View adult BNF View SPC online View childrens BNF
Formulary
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Secondary care notes

  • NMUH approvals:
    • Nil
  • RFL approvals:
    • Range of sizes stocked
  • RNOH approvals:
    • Nil
  • UCLH approvals:
  • WH approvals:
    • For use with Airomir (salbutamol) and QVAR (beclometasone) inhalers
 
   
Spacer (Babyhaler®)
View adult BNF View SPC online View childrens BNF
Formulary
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Secondary care notes

  • NMUH approvals:
    • Not applicable
  • RFL approvals:
    • Not applicable
  • RNOH approvals:
    • Not applicable
  • UCLH approvals:
  • WH approvals:
    • Spacer inhaler with paediatric face mask.
 
   
Spacer (Haleraid®)
View adult BNF View SPC online View childrens BNF
Formulary
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Secondary care notes

  • NMUH approvals:
    • Not applicable
  • RFL approvals:
    • Nil
  • RNOH approvals:
    • Nil
  • UCLH approvals:
  • WH approvals:
    • Not applicable
 
   
Spacer (Volumatic®)
View adult BNF View SPC online View childrens BNF
Formulary
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Secondary care notes

  • NMUH approvals:
    • Nil
  • RFL approvals:
    • Nil
  • RNOH approvals:
    • Nil
  • UCLH approvals:
  • WH approvals:
    • For use with Salamol (salbutamol), beclometasone (non-CFC-free) and fluticasone inhalers.
 
   
03.01.05  Expand sub section  Nebulisers
03.01.05  Expand sub section  Nebuliser Diluent
Sodium Chloride 0.9% nebuliser solution
View adult BNF View SPC online View childrens BNF
Formulary
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Secondary care notes

  • NMUH approvals:
    • Sodium chloride 0.9% ampoules are used via nebuliser
  • RFL approvals:
    • Nil
  • RNOH approvals:
    • Not applicable
  • UCLH approvals:
  • WH approvals:
    • Not applicable
 
   
 ....
 Non Formulary Items
Aclidinium  (Eklira Genuair®)

View adult BNF View SPC online View childrens BNF
Non Formulary
Black

Not approved for COPD (May 2013)

 
Aclidinium + Formoterol inhaler  (Duaklir Genuair ®)

View adult BNF View SPC online View childrens BNF
Non Formulary
Black

Not approved for COPD (August 2016)

 
Alpha-1 antitrypsin  (Respreeza®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Bambuterol  (Bambec®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Compressors  (Omron® compAIR CX)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Compressors  (Omron® CX3)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Compressors  (System 22® CR60)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Compressors  (Turboneb®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Duovent

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Ephedrine tablets
(Respiratory)

View adult BNF View SPC online View childrens BNF
Non Formulary

Secondary care notes

  • NMUH approvals:
    • Not applicable
  • RFL approvals:
    • Not applicable
  • RNOH approvals
    • Not applicable
  • UCLH approvals:
  • WH approvals:
    • Not applicable
 
Fenoterol

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Flo-Tone MDI

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Formoterol fumarate  (Atimos® Modulite pMDI)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Formoterol fumarate  (Foradil® powder capsules for inhalation)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Glycopyrronium  (Seebri breezhaler®)

View adult BNF View SPC online View childrens BNF
Non Formulary
Black

Not approved for COPD (May 2013)

 
Glycopyrronium + Indacaterol inhaler  (Ultibro Breezhaler®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Home Compressors with Nebulisers  (AC 200® HI FLO)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Home Compressors with Nebulisers  (AC 4000®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Home Compressors with Nebulisers  (Aquilon®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Home Compressors with Nebulisers  (De-Vibiss 4650®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Home Compressors with Nebulisers  (De-Vibiss 5650®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Home Compressors with Nebulisers  (Econoneb®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Home Compressors with Nebulisers  (Freeway Freedom®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Home Compressors with Nebulisers  (PARI BOY Mobile® S)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Home Compressors with Nebulisers  (PARI JuniorBOY ®S)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Home Compressors with Nebulisers  (PARI TurboBOY® S)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Home Compressors with Nebulisers  (Porta-Neb®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Home Compressors with Nebulisers  (Tourer®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Home Compressors with Nebulisers  (ultima®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Home Compressors with Nebulisers  (World Traveller® HI FLO)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Indacaterol  (Onbrez® Breezhaler)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Ipratropium bromide + Salbutamol  (Combivent®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Jet Nebulisers  (Medix® Lifecare Nebuliser System)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Jet Nebulisers  (Medix® Lifecare Nebuliser Chamber)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Jet Nebulisers  (PARI LC® SPRINT)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Jet Nebulisers  (PARI LC® SPRINT BABY)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Jet Nebulisers  (Sidestream® Durable)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Jet Nebulisers  (Ventistream®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Low range peak flow meter  (Pocketpeak®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Nedocromil inhaler  (Tilade® CFC-free inhaler)

View adult BNF View SPC online View childrens BNF
Non Formulary

Secondary care notes

  • NMUH approvals:
    • Not applicable
  • RFL approvals:
    • Not applicable
  • RNOH approvals
    • Not applicable
  • UCLH approvals:
  • WH approvals:
    • Not applicable
 
Olodaterol  (Striverdi Respimat®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Orciprenaline Sulphate  (Alupent®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Salbutamol  (Airomir® pMDI)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Salbutamol  (Asmasal Clickhaler®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Salbutamol  (Easyhaler®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Salbutamol  (Salbulin Novolizer®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Salbutamol  (Volmax®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Sodium Cromoglicate inhaler  (Intal CFC-free inhaler®)

View adult BNF View SPC online View childrens BNF
Non Formulary

Secondary care notes

  • NMUH approvals:
    • Not Applicable
  • RFL approvals:
    • Not applicable
  • RNOH approvals
    • Not Applicable
  • UCLH approvals:
  • WH approvals:
    • Not Applicable
 
Spacer  (A2A Spacer®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Spacer  (Able Spacer®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Spacer  (OptiChamber®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Spacer  (OptiChamber® Diamond)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Spacer  (Pocket Chamber®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Spacer  (Space Chamber Plus®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Spacer  (Vortex®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Standard range peak flow meter  (MicroPeak®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Standard range peak flow meter  (Piko-1®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Standard range peak flow meter  (Pocketpeak®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Standard range peak flow meter  (Vitalograph®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Tiotropium + Olodaterol  (Spiolto Respimat®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Ultrasonic Nebulisers  (F16 Wave®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Ultrasonic Nebulisers  (Liberty®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Ultrasonic Nebulisers  (Omron MicroAIR®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Ultrasonic Nebulisers  (Omron® NE-U17)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Ultrasonic Nebulisers  (Ultra Neb ®2000)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
  
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
click to search medicines.org.uk
Link to adult BNF
click to search medicines.org.uk
Link to children's BNF
click to search medicines.org.uk
Link to SPCs
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

GP - 1st

Medicines suitable for first-line use within primary care.

Can be initiated within primary care within their licensed indication, in accordance with nationally recognised formularies, for example the BNF, BNF for Children, Medicines for Children or Palliative Care Formulary. Primary care prescribers take full responsibility for prescribing. 

  

GP - 2nd

Medicines suitable for second-line use within primary care.

Can be initiated within primary care within their licensed indication, in accordance with nationally recognised formularies, for example the BNF, BNF for Children, Medicines for Children or Palliative Care Formulary. Primary care prescribers take full responsibility for prescribing. 

  

GP - Amber

Medicines that should be initiated by a specialist. Prescribing can be transferred to primary care once the patient has been stabilised.  

Shared care: For drugs with regular, ongoing need for monitoring and/or assessment of efficacy or toxicity. Prior agreement must be obtained by the specialist from the primary care provider before prescribing responsibility is transferred. The shared care protocol must have been agreed by the relevant secondary care trust Drugs and Therapeutics Committee(s) (DTC) and approved by the North Central London JFC.

Fact sheet: For drugs with some concerns surrounding safety or efficacy but do not require regular monitoring and/or monitoring of effectiveness/toxicity.

  

GP - Red

Medicines which should normally be prescribed by specialists only (hospital only).

For patients already receiving prescriptions in primary care - continue. No new patients to receive prescriptions in primary care.

  

GP - Grey

Medicines on hospital formularies which have not been reviewed for suitability in primary care.  

Black

Medicines not recommended for routine use in primary or secondary care.

Medicines, which the North Central London JFC has actively reviewed and does not recommend for use at present due to limited clinical and/or cost effective data.

  

netFormulary