Guide to Inhaled Treatment Choices Note: this is guidance only, it is important to consider which device is best suited to the patient. This may NOT be the first line choice (but should be on the joint formulary). Device Dose Counter Dose Check MDI - Visual Consider if low inspiratory flow. Always use with spacer device. Easy to use, consider Haleraid to help grip and press the canister if dexterity problems. Device Dose Counter Dose Check Respimat + Dose pointer enters the red area of the scale (7 days remaining) Visual Used in COPD only Requires priming before use. Easy to use, requires dexterity to prime device. Consider if low inspiratory flow. Device Accuhaler + Dose indicator with last 5 doses. Genuair + Dose indicator counts down in intervals of 10 (last 10 red). Dry Powder inhalers (DPI) Dose Counter Dose Check Note: all DPIs require sufficient inspiratory flow Visual/ Lactose taste Audible/ Visual/ Lactose taste NEXThaler + Audible/ Visual/ Lactose taste Turbohaler + Visual/ Lactose Cog-wheel dose indicator taste with last 20 doses marked in red. Pre-loaded, primed by opening Easy to use, requires minimal dexterity to prime. Used in COPD only Pre-loaded, primed by pressing button (coloured control window moves from red to green). Easy to use, required minimal dexterity. Requires sufficient inspiratory flow (coloured control window moves from green to red on inhalation). Pre-loaded, primed by opening. Easy to use, requires minimal dexterity. Pre-loaded, primed by twisting. Easy to use, consider Turbohaler Turning Aid if poor dexterity. Breezhaler - Capsule vibration Load each time with separate capsule, must pierce capsule. Required dexterity to load device. Advise patient not to swallow capsule. Zonda - Capsule vibration Used in COPD only Load each time with separate capsule, must pierce capsule. Required dexterity to load device. Capsule should be placed in centre chamber, NOT in mouthpiece. Advise patient not to swallow capsule. Information obtained from Mims for nurses: Respiratory devices Visual Guide, guide to Breath-Actuated Inhaler Full guidance available at mims.co.uk Key MDI = Metered dose inhaler DPI = Dry Powder Inhaler + yes - No
SABA-Short Acting Beta 2 Agonist Inhalers Salbutamol CFC Free 100 micrograms / dose (MDI) 1.50 / 200 doses FIRST LINE for COPD and Asthma effective salbutamol MDI inhaler Salbutamol Autohaler 100 micrograms / dose (MDI) 6.30 / 200 doses Should be reserved for use in patients that have difficulty synchronising aerosol actuation with inspiration of breath Salbutamol Easibreathe 100 micrograms / dose (MDI) 6.30 / 200 doses Should be reserved for use in patients that have difficulty synchronising aerosol actuation with inspiration of breath 3 / 60 doses Salbutamol Accuhaler 200 micrograms / dose (DPI) Bricanyl Turbuhaler Terbutaline 500 micrograms / dose (DPI) 6.92 / 100 doses
LABA-Long Acting Beta2 Agonist Inhalers Serevent Salmeterol 25 micrograms / dose (MDI) 29.26 / 120 doses. Licensed age 4+. 26.26 / 60 Serevent Accuhaler Salmeterol 50 micrograms / dose (DPI) Formoterol Easyhaler 12micrograms / dose (DPI) 23.75 / 120 doses Licensed 6+. Oxis Turbohaler Formoterol 6 micrograms / dose (DPI) 24.80 / 60 doses Oxis Turbohaler Formoterol 12micrograms / dose (DPI) 24.80 / 60 doses
SAMA-Short Acting Muscarinic Antagonist Inhalers Atrovent Ipratropium bromide 20 micrograms / dose (MDI) 23 / 60 doses. Prescribe by Atrovent brand as this is the only brand that can be used with a spacer device LAMA-Long Acting Muscarinic Antagonist Inhalers Eklira Genuair Aclidinium 400micrograms / dose (DPI) (delivers 322 micrograms of aclidinium) 28.60 / 60 doses Licensed for COPD only. Alternative to tiotropium. Less published evidence but device may be easier to use for those with dexterity issues. Braltus Zonda Inhaler Tiotropium 10micrograms / dose (DPI) 25.80 / 30 doses FIRST Line in COPD for new and existing patients Licensed for COPD only. The Braltus Zonda and Spiriva Handihaler deliver the same dose (10mcg). Capsule should be placed in centre chamber, NOT in mouthpiece. Spiriva Handihaler Tiotropium 18 micrograms / dose (DPI) Handihaler device + capsules 34.87 / 30 doses Refill capsules 33.50 / 30 doses Licensed for COPD only. Second line choice brand for DPI tiotropium inhaler for new and existing patients. (The Braltus Zonda and Spiriva Handihaler deliver the same dose (10mcg).) Spiriva Respimat Tiotropium 2.5micrograms / dose (MDI) 23 / 60 doses Locally approved for COPD only although licensed for COPD and asthma.
ICS-INHALED CORTICOSTEROID INHALERS Clenil Modulite CFC Free Beclometasone 50 micrograms / dose (MDI) 3.70 / 200 doses Prescribe by brand name Clenil Modulite.. Clenil Modulite CFC Free Beclometasone 100 micrograms / dose (MDI) 7.42 / 200 doses Prescribe by brand name Clenil Modulite.. Clenil Modulite CFC Free Beclometasone 200 micrograms / dose (MDI) 16.17 / 200 doses Prescribe by brand name Clenil Modulite.. Clenil Modulite CFC Free Beclometasone 250 micrograms / dose (MDI) 16.29 / 200 doses Prescribe by brand name Clenil Modulite.. Qvar CFC-FREE Beclometasone 50 micrograms / dose (MDI) 7.87 / 200 doses Prescribe by brand name Qvar. (Can only be used with the AeroChamber Plus spacer device)
ICS-INHALED CORTICOSTEROID INHALERS Qvar CFC-FREE Beclometasone 100 micrograms / dose (MDI) 17.21 / 200 doses Prescribe by brand name Qvar. (Can only be used with the AeroChamber Plus spacer device) Beclometasone Easibreathe 50 micrograms / dose (MDI) 7.74 / 200 doses Beclometasone Easibreathe 100 micrograms / dose (MDI) 16.95 / 200 doses Budesonide Easyhaler 100 micrograms / dose (DPI) 8.86 / 200 doses Budesonide Easyhaler 200 micrograms / dose (DPI) 17.71 / 200 doses
ICS-INHALED CORTICOSTEROID INHALERS Budesonide Easyhaler 400 micrograms / dose (DPI) 17.71 / 100 doses Pulmicort Turbohaler Budesonide 100 micrograms / dose (DPI) 11.84 / 200 doses Pulmicort Turbohaler Budesonide 200 micrograms / dose (DPI) 11.84 / 100 doses Pulmicort Turbohaler Budesonide 400 micrograms / dose (DPI) 13.86 / 50 doses Flixotide CFC free inhaler Fluticasone 50 micrograms / dose (MDI) 5.44 / 120 doses.
ICS-INHALED CORTICOSTEROID INHALERS Flixotide CFC free MDI inhaler Fluticasone 125 micrograms / dose (MDI) 21.26 / 120 doses. Flixotide CFC free MDI inhaler Fluticasone 250 micrograms / dose (MDI) 21.26/120 doses. Flixotide Accuhaler Fluticasone 50 micrograms / dose (DPI) 6.38 / 60 doses Flixotide Accuhaler Fluticasone 100 micrograms / dose (DPI) 8.93 / 60 doses Flixotide Accuhaler Fluticasone 250 micrograms / dose (DPI) 21.26 / 60 doses
ICS-INHALED CORTICOSTEROID INHALERS Flixotide Accuhaler Fluticasone 500 micrograms / dose (DPI) 36.14 / 60 doses LABA/ICS COMBINATION INHALERS Fostair 100 / 6, beclometasone 100 micrograms and formoterol 6 micrograms / dose (MDI) 29.32 / 120 doses FIRST line in COPD Prescribe by brand name Fostair Contains a small amount of ethanol Fostair 200 / 6 beclometasone 200 mcgs and formoterol 6 mcgs / dose (MDI) 29.32 / 120 doses Prescribe by brand name Fostair Contains a small amount of ethanol Fostair NEXThaler 100 / 6, beclometasone 100 micrograms and formoterol 6 micrograms / dose (DPI) 29.32 / 120 doses Prescribe by brand name Fostair Nexthaler. Fostair NEXThaler 200 / 6, beclometasone 200 micrograms and formoterol 6 micrograms / dose (DPI) 29.32 / 120 doses Prescribe by brand name Fostair Nexthaler.
LABA/ICS COMBINATION INHALERS DuoResp Spiromax 160 / 4.5, budesonide 160 micrograms and formoterol 4.5 micrograms / dose (MDI) 29.97/120 doses Prescribe by brand name Duoresp Spiromax effective inhaler combination of budesonide and formoterol. DuoResp Spiromax 320 / 9, budesonide 320 micrograms and formoterol 9 micrograms / dose (MDI) 29.97/120 doses Prescribe by brand name Duoresp Spiromax effective inhaler combination of budesonide and formoterol. Symbicort Turbohaler 100 / 6, budesonide 100 micrograms and formoterol 6 micrograms / dose (DPI) 33/ 120 doses Prescribe by brand name Symbicort Turbohaler Symbicort Turbohaler 200 / 6, budesonide 200 micrograms and formoterol 6 micrograms / dose (DPI) 38/120 doses Prescribe by brand name Symbicort Turbohaler Symbicort Turbohaler 400 / 12, budesonide 400 micrograms and formoterol 12 micrograms/dose (DPI) 38/60 doses Prescribe by brand name Symbicort Turbohaler
LABA/ICS COMBINATION INHALERS Airflusal Fospiro 500 / 50 fluticasone 500 micrograms and salmeterol 50 micrograms / dose (DPI) 32.74 / 60 dose Prescribe by brand name Airflusal Licensed for COPD only Seretide Accuhaler 100 / 50 fluticasone 100 micrograms and salmeterol 50 micrograms / dose (DPI) 18 / 60 doses Prescribe by brand name Seretide Accuhaler Seretide Accuhaler 250 / 50 fluticasone 250 micrograms and salmeterol 50 micrograms / dose (DPI) 35 / 60 doses Prescribe by brand name Seretide Accuhaler Seretide Accuhaler 500 / 50 fluticasone 500 micrograms and salmeterol 50 micrograms / dose (DPI) 40 / 60 doses Prescribe by brand name Seretide Accuhaler Sirdupla 125/25 fluticasone 125 micrograms and salmeterol 25 micrograms / dose (MDI) 26.25 / 120 doses Prescribe by brand name Sirdupla
LABA/ICS COMBINATION INHALERS Sirdupla 250 / 25 fluticasone 250 micrograms and salmeterol 25 micrograms / dose (MDI) 44.61 / 120 doses Prescribe by brand name Sirdupla Seretide Evohaler 50 / 25 fluticasone 50 micrograms and salmeterol 25 micrograms / dose (MDI) 18 / 120 doses Prescribe by brand name Seretide Evohaler Seretide Evohaler 125 / 25 fluticasone 125 micrograms and salmeterol 25 micrograms / dose (MDI) 21.26 / 120 doses Prescribe by brand name Seretide Evohaler Seretide Evohaler 250 / 25 fluticasone 250 micrograms and salmeterol 25 micrograms / dose (MDI) 59.48 / 120 doses Prescribe by brand name Seretide Evohaler
LABA/LAMA COMBINATION INHALERS Duaklir Genuair aclidinium 400 micrograms (as bromide 340 micrograms), formoterol (as fumarate dihydrate) 12 micrograms (DPI) 32.50/ 60 doses Prescribe by brand name Duaklir Genuair Licensed for COPD only Spiolto Respimat tiotropium (as bromide monohydrate) 2.5 micrograms, olodaterol (as hydrochloride) 2.5micrograms (MDI) 32.50/ 60 doses FIRST Line in COPD Prescribe by brand name Spiolto Respimat Licensed for COPD only Ultibro Breezhaler glycopyrronium bromide 43 micrograms and indacaterol malete 85micrograms / dose (DPI) 32.50 / 30 doses Prescribe by brand name Ultibro Breezhaler Licensed for COPD only Severe renal impairment or end stage renal dialysis only use if the expected benefit outweighs the risk
SPACER DEVICES Able Spacer (Clement Clarke) 4.39 Small-volume device. For use with all pressurised (aerosol) inhalers, with infant or child mask AeroChamber Plus (GSK) 4.86 (With mask 8.11) Medium-volume device. For use with all pressurised (aerosol) inhalers. Standard device (blue), infant device (orange) with mask, child device (yellow) with mask. Volumatic (A&H) 3.85 Large-volume device. For use with Clenil Modulite, Flixotide, Seretide, Serevent and Salbutamol MDI inhalers
Links to Inhaler Training Videos Accuhaler: https://player.vimeo.com/video/178617772 Metered Dose Inhaler: https://player.vimeo.com/video/179464068 Metered Dose Inhaler & Volumatic spacer device: https://player.vimeo.com/video/179464174 Metered Dose Inhaler & AeroChamber Plus spacer device: https://player.vimeo.com/video/179464864 Autohaler: https://player.vimeo.com/video/178617776 Breezhaler Inhaler: https://player.vimeo.com/video/178617778 Easi-Breathe Inhaler: https://player.vimeo.com/video/178617774 Easyhaler Inhaler: https://player.vimeo.com/video/178887205 Fospiro Inhaler: https://player.vimeo.com/video/180739286 Genuair Inhaler: https://player.vimeo.com/video/178617775 Spiriva Handihaler Inhaler: https://player.vimeo.com/video/178617777 NEXThaler Inhaler: https://player.vimeo.com/video/180738083 Respimat Inhaler: https://player.vimeo.com/video/178874074 Spiromax Inhaler: https://player.vimeo.com/video/179442880 Turbohaler Inhaler: https://player.vimeo.com/video/178887846