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Respiratory InhalersIdentification GuideVersion 2230801This booklet has been produced by NHS Greater Glasgow and Clyde together with the following companies,Almirall, AstraZeneca, Boehringer Ingelheim Ltd, Chiesi, GSK, Napp and Novartis as a service to medicine.Endorsed by NHSGGC Respiratory Managed Clinical Network, September 2013Designed by Medical Illustration ServicesProduced by NHSGGC Medicines Information, September 2013. Endorsed by Respiratory Managed Clinical Network.

CONTENTSExample Costs of Respiratory Inhaler DevicesRecommendations for Inhaler SupplyRespiratory Inhaler Identification• Short-acting beta 2agonist inhalers (SABAs)• Long-acting beta 2agonist inhalers (LABAs)• Short-acting muscarinic antagonists (SAMAs)• Long-acting muscarinic antagonists (LAMAs)• Corticosteroid inhalersSalbutamolTerbutalineSalmeterolFormoterolIndacaterolIpratropiumTiotropiumAclidiniumGlycopyrroniumBeclometasoneFluticasoneBudesonide• Compound preparations Seretide ®Symbicort ®Fostair ®Flutiform ®Spacer Devices

Recommendations for Inhaler Supply** Important points to consider before issuing or prescribing inhalers **• Approximately £1.5 million was spent in 2012/13 on inhalers within NHSGGC Acute care. A lot of inhaler wastageoccurs across NHSGGC Acute and most would be considered preventable.• By adhering to the following recommendations, inhaler wastage could be minimised. Patient safety would also beimproved by ensuring patients receive the correct inhaler, strength and device during hospital admission.• Encourage the use of patient’s own inhalers.• Always ask patients if they have their own inhaler(s) before ordering or issuing a new inhaler. If patients have theirown inhaler(s), check the expiry date and if it is the current inhaler prescribed by the GP. If they don’t havetheir inhaler, ask if a relative or carer could bring it in at their earliest convenience.• If a patient is transferred to another ward, ensure inhaler(s) are transferred with the patient. Similarly, if a patienthas been transferred from another ward, always check if they have been issued with inhaler(s) prior to transfer.• Always check what type of inhaler device and strength the patient uses before ordering or issuing a new one. Ifunsure, discuss with the doctor, clinical pharmacist, or respiratory nurse specialist.• Ensure the correct device is clearly prescribed on the medicine prescription form (e.g. Accuhaler ® , turbohaler ® ,evohaler ® ) prior to administration.• Always check if a patient has an inhaler before documenting code ‘13’ (patient self administration) on the medicineprescription form. Do not assume that patients have their own inhalers and they are using them as prescribed.• When patients are started on inhalers for the first time, inhaler technique should be assessed. Seek advice frompharmacy or respiratory nurse specialist if unsure of the most suitable device.** Stop and think before ordering, issuing or prescribing inhalers ** (costs from Ascribe business objects acute database)Produced by NHSGGC Medicines Information, September 2013. Endorsed by Respiratory Managed Clinical Network.

Bronchodilator – short-acting beta 2agonist (blue/reliever) Inhalers (SABAs)SALBUTAMOLAdult DoseBy aerosol inhalation100-200 micrograms; for persistentsymptoms up to 4 times daily. Referto manufacturer’s dosing instructionsor BNF for further advice.Salbutamol Salamol Airomir*MDI (aerosol) Easi-Breathe ® Autohaler ®(brands include (aerosol) (aerosol)Ventolin evohaler ® )Strength: 100 micrograms/ Strength: 100 micrograms/ Strength: 100 micrograms/metered inhalation metered inhalation metered inhalationSalbutamol 100 micrograms√2 puffs Inhal SOB/wheeze4 x 01/02/13A N Other (A N OTHER)dayVentolin evohalerExample of medicine prescription form(*MDI = metered-dose inhaler)NB. Different strengths of inhalers may be slightly different colours to those illustrated.Produced by NHSGGC Medicines Information, September 2013. Endorsed by Respiratory Managed Clinical Network.

Bronchodilator – short-acting beta 2agonist (blue/reliever) Inhalers (SABAs)SALBUTAMOLPulvinal ® Easyhaler ® Asmasal VentolinSalbutamol Salbutamol Clickhaler ® Accuhaler ®(dry powder) (dry powder) (dry powder) (dry powder)Strength: 200 Strengths: 100, 200 Strength: 95 Strength: 200micrograms/ micrograms/ micrograms/ micrograms/metered inhalation^ metered inhalation^ metered inhalation^ metered inhalation^^Refer to manufacturer’s dosinginstructions or BNF for furtheradvice.√Salbutamol 200 micrograms1 puff Inhal SOB/wheezeA N Other (A N OTHER)Ventolin accuhaler4 xday01/02/13Example of medicine prescription formNB. Different strengths of inhalers may be slightly different colours to those illustrated.Produced by NHSGGC Medicines Information, September 2013. Endorsed by Respiratory Managed Clinical Network.

Bronchodilator – short-acting beta 2agonist (blue/reliever) Inhalers (SABAs)TERBUTALINE SULPHATEAdult DoseBy inhalation of powder500 micrograms; for persistent symptomsup to 4 times daily. Refer to manufacturer’sdosing instructions or BNF for further advice.BricanylTurbohaler ®(dry powder)Strength: 500micrograms/metered inhalation√Terbutaline 500 micrograms1 puff Inhal SOB/wheezeA N Other (A N OTHER)Bricanyl turbohaler4 xday01/02/13Example of medicine prescription formNB. Different strengths of inhalers may be slightly different colours to those illustrated.Produced by NHSGGC Medicines Information, September 2013. Endorsed by Respiratory Managed Clinical Network.

Long-acting beta 2agonist Inhalers (LABAs)SALMETEROLSereventSerevent Diskhaler ® SereventAccuhaler ® (dry powder)Evohaler ®(dry powder)MDI (aerosol)Strength: 50 micrograms/meteredinhalationAdult DoseBy inhalation of dry powder50 micrograms twice daily;up to 100 micrograms twice daily.Refer to manufacturer’s dosinginstructions or BNF for further advice.Strength: 50 micrograms/blisterStrength: 25 micrograms/metered inhalationNeovent ®MDI (aerosol)Strength: 25 micrograms/metered inhalationAdult DoseBy aerosol inhalation50 micrograms twice daily; up to100 micrograms twice daily.Refer to manufacturer’s dosinginstructions or BNF for further advice.√Salmeterol 50 micrograms1 puff Inhal 01/02/13√√Salmeterol 25 micrograms2 puffs Inhal 01/02/13√A N Other (A N OTHER)Serevent accuhalerExample of medicine prescription form√A N Other (A N OTHER)√Serevent evohalerExample of medicine prescription formNB. Different strengths of inhalers may be slightly different colours to those illustrated.Produced by NHSGGC Medicines Information, September 2013. Endorsed by Respiratory Managed Clinical Network.

Long-acting beta 2agonist Inhalers (LABAs)FORMOTEROL FUMARATEOxisTurbohaler ®(dry powder)Strengths^: 6, 12 micrograms/metered inhalationEasyhaler ® Formoterol(dry powder)Strength: 12 micrograms/meteredinhalation^Atimos Modulite ®(aerosol)Strength: 12 micrograms/metered inhalation^^Refer to manufacturer’s dosinginstructions or BNF for further advice.√Formoterol 12 micrograms1 puff Inhal 01/02/13A N Other (A N OTHER)√Oxis turbohalerNB. Different strengths of inhalers may be slightly different colours to those illustrated.Example of medicine prescription formProduced by NHSGGC Medicines Information, September 2013. Endorsed by Respiratory Managed Clinical Network.

Long-acting beta 2agonist Inhalers (LABAs)INDACATEROLAdult Dose:By inhalation of dry powder150 micrograms once daily,increased to max. 300micrograms once daily.Refer to manufacturer’sdosing instructions or BNFfor further advice.√Indacaterol150 micrograms Inhal 01/02/13A N Other (A N OTHER)Onbrez breezhaler√Onbrez Breezhaler ®(inhalation powder, hard capsule)Strengths: 150, 300 micrograms/metered inhalationExample of medicine prescription formNB. Different strengths of inhalers may be slightly different colours to those illustrated.Produced by NHSGGC Medicines Information, September 2013. Endorsed by Respiratory Managed Clinical Network.

Antimuscarinic Bronchodilator Inhalers – short-acting muscarinic antagonists (SAMAs)IPRATROPIUM BROMIDEAdult DoseBy aerosol inhalation20-40 micrograms 3-4times daily. Refer tomanufacturer’s dosinginstructions or BNF forfurther advice.√Ipratropium bromide 20 micrograms2 puffs Inhal 01/02/13A N Other (A N OTHER)Atrovent MDI√√√Atrovent ®MDI (aerosol)Strength: 20 micrograms/metered inhalationExample of medicine prescription formNB. Different strengths of inhalers may be slightly different colours to those illustrated.Produced by NHSGGC Medicines Information, September 2013. Endorsed by Respiratory Managed Clinical Network.

Antimuscarinic Bronchodilator Inhalers – long-acting muscarinic antagonists (LAMAs)TIOTROPIUMSpiriva ®(inhalation powder, hard capsulefor use with HandiHaler ® device)Strength: 18 microgram capAdult DoseBy inhalation of powder18 micrograms once daily.Refer to manufacturer’sdosing instructions orBNF for further advice.Tiotropium√√18 micrograms Inhal 01/02/13A N Other (A N OTHER)Spiriva HandihalerExample of medicine prescription formAdult doseBy inhalation5 micrograms (2 puffs)once daily. Refer tomanufacturer’s dosinginstructions or BNF forfurther advice.√Tiotropium 2.5 micrograms2 puffs Inhal 01/02/13A N Other (A N OTHER)Spiriva Respimat√Spiriva Respimat ®(solution for inhalation) Please note. Spiriva Respimat is currently non-formulary in NHSGGC.Strength: 2.5 micrograms/metered inhalationNB. Different strengths of inhalers may be slightly different colours to those illustrated.Produced by NHSGGC Medicines Information, September 2013. Endorsed by Respiratory Managed Clinical Network.Example of medicine prescription form

Antimuscarinic Bronchodilator Inhalers – long-acting muscarinic antagonists (LAMAs)ACLIDINIUM BROMIDEAdult DoseBy inhalation of dry powder1 inhalation twice daily.Refer to manufacturer’s dosinginstructions or BNF for further advice.√Aclidinium 322 micrograms1 puff Inhal 01/02/13A N Other (A N OTHER)Eklira Genuair√√Eklira Genuair ®(dry powder)Example of medicine prescription formStrength: 400 micrograms/metered inhalationEquivalence: each 400 micrograms meteredinhalation of aclidinium bromide delivers 375micrograms of aclidinium bromide which isequivalent to 322 micrograms of aclidinium.NB. Different strengths of inhalers may be slightly different colours to those illustrated.Produced by NHSGGC Medicines Information, September 2013. Endorsed by Respiratory Managed Clinical Network.

Antimuscarinic Bronchodilator Inhalers – long-acting muscarinic antagonists (LAMAs)GLYCOPYRRONIUMAdult DoseBy inhalation of powder50 microgramsonce daily. Refer tomanufacturer’s dosinginstructions or BNF forfurther advice.√Glycopyrronium50 micrograms Inhal 01/02/13A N Other (A N OTHER)√Seebri BreezhalerSeebri Breezhaler ®(inhalation powder, hard capsule)Strength: 50 micrograms capExample of medicine prescription formEquivalence: each 50 microgram capsuleof glycopyrronium delivers 44 microgramsof glycopyrroniumNB. Different strengths of inhalers may be slightly different colours to those illustrated.Produced by NHSGGC Medicines Information, September 2013. Endorsed by Respiratory Managed Clinical Network.

Corticosteroid (brown/preventer) InhalersBECLOMETASONE DIPROPIONATE** NOTE:BECLOMETASONE CFC-FREE AEROSOL INHALERS ARE NOT INTERCHANGEABLE AND MUST BE PRESCRIBED BY BRAND NAME **Adult DoseBy aerosol inhalation200-400 micrograms twicedaily (up to 1mg twice daily)Refer to manufacturer’sdosing instructions or BNF forfurther advice.√Clenil modulite 100 micrograms2 puffs Inhal 01/02/13A N Other (A N OTHER)MDI√√Clenil Modulite ®(CFC-free) MDI (aerosol)Strengths: 50, 100, 200, 250 micrograms/metered inhalationExample of medicine prescription formNB. Different strengths of inhalers may be slightly different colours to those illustrated.Produced by NHSGGC Medicines Information, September 2013. Endorsed by Respiratory Managed Clinical Network.

Corticosteroid (brown/preventer) InhalersBECLOMETASONE DIPROPIONATE** NOTE:BECLOMETASONE CFC-FREE AEROSOL INHALERS ARE NOT INTERCHANGEABLE AND MUST BE PRESCRIBED BY BRAND NAME **Qvar ® Qvar Autohaler ®(CFC-free) MDI (aerosol) (aerosol)Strengths: 50, 100 micrograms/metered inhalationStrengths: 50, 100 micrograms/metered inhalationQvar Easi-Breathe ®(aerosol)Strengths: 50, 100 micrograms/metered inhalationAdult DoseBy aerosol inhalation50-200 micrograms twicedaily (up to 400 microgramstwice daily). Referto manufacturer’s dosinginstructions or BNF forfurther advice.√Qvar 100 micrograms1 puff Inhal 01/02/13√A N Other (A N OTHER)MDIExample of medicine prescription formNB. Different strengths of inhalers may be slightly different colours to those illustrated.√Produced by NHSGGC Medicines Information, September 2013. Endorsed by Respiratory Managed Clinical Network.

Corticosteroid (brown/preventer) InhalersBECLOMETASONE DIPROPIONATE√Beclometasone 200 micrograms1 puff Inhal 01/02/13A N Other (A N OTHER)Dry powder inhaler (Easyhaler)√√Pulvinal ® Easyhaler ® AsmabecBeclometasone Beclometasone Clickhaler ®(dry powder) (dry powder) (dry powder)Example of medicine prescription formStrengths^: 100, 200, Strength^: 200 Strengths^: 100, 250400 micrograms/ micrograms/ micrograms/meteredmetered inhalation metered inhalation inhalation^^Refer to manufacturer’s dosinginstructions or BNF for further advice.NB. Different strengths of inhalers may be slightly different colours to those illustrated.Produced by NHSGGC Medicines Information, September 2013. Endorsed by Respiratory Managed Clinical Network.

Corticosteroid (brown/preventer) InhalersFLUTICASONE PROPIONATEAdult DoseBy aerosol inhalation100-500 micrograms twicedaily (up to 1mg twice daily)Refer to manufacturer’sdosing instructions or BNFfor further advice.Adult DoseBy inhalation of dry powder100-500 micrograms twicedaily (up to 1mg twice daily)Refer to manufacturer’sdosing instructions or BNFfor further advice.FlixotideFlixotideEvohaler ® Accuhaler ®MDI (aerosol)(dry powder)Strengths: 50, 125, 250 Strengths: 50, 100, 250, 500micrograms/meteredmicrograms/meteredinhalationinhalation√Fluticasone 125 micrograms2 puffs Inhal 01/02/13√√Fluticasone 250 micrograms1 puff Inhal 01/02/13√A N Other (A N OTHER)Flixotide evohaler√A N Other (A N OTHER)Flixotide accuhaler√Example of medicine prescription formExample of medicine prescription formNB. Different strengths of inhalers may be slightly different colours to those illustrated.Produced by NHSGGC Medicines Information, September 2013. Endorsed by Respiratory Managed Clinical Network.

Corticosteroid (brown/preventer) InhalersBUDESONIDEPulmicortTurbohaler ®(dry powder)Strengths^: 100, 200, 400micrograms/metered inhalationEasyhaler ® budesonide(dry powder)Strengths^: 100, 200, 400 micrograms/metered inhalationBudelin novolizer ®(dry powder)Strength: 200 micrograms/metered inhalation^^Refer to manufacturer’s dosinginstructions or BNF for further advice.√Budesonide 200 micrograms1 puff Inhal 01/02/13√A N Other (A N OTHER)Pulmicort turbohaler√NB. Different strengths of inhalers may be slightly different colours to those illustrated.Example of medicine prescription formProduced by NHSGGC Medicines Information, September 2013. Endorsed by Respiratory Managed Clinical Network.

Compound Preparations (Corticosteroid/ Long-acting beta 2agonist)BUDESONIDE/FORMOTEROLSymbicort Maintenance TherapySymbicort Reliever Therapy√Symbicort 200/6 turbohaler2 puffs Inhal 01/02/13√√Symbicort 200/61 puff Inhal SOB/wheezeA N Other (A N OTHER)√A N Other (A N OTHER)Max. 6 puffs on any one occasion8 xday01/02/13Symbicort Turbohaler ®(dry powder)Example of medicine prescription formStrengths^:100/6 Turbohaler ® (budesonide 100 micrograms/formoterol 6micrograms)200/6 Turbohaler ® (budesonide 200 micrograms/formoterol 6micrograms)400/12 Turbohaler ® (budesonide 400 micrograms/formoterol 12micrograms)Example of medicine prescription form^Refer to manufacturer’s dosinginstructions or BNF for further advice.NB. Different strengths of inhalers may be slightly different colours to those illustrated.Produced by NHSGGC Medicines Information, September 2013. Endorsed by Respiratory Managed Clinical Network.

Compound Preparations (Corticosteroid/ Long-acting beta 2agonist)BECLOMETASONE/FORMOTEROLFostair Maintenance TherapyFostair Reliever Therapy√Fostair 100/61 puff Inhal 01/02/13A N Other (A N OTHER)MDI√√√Fostair 100/61 puff Inhal SOB/wheezeA N Other (A N OTHER)6 xday01/02/13Fostair ®(aerosol)Strength: 100/6 (belcometasone 100 micrograms/formoterol 6 micrograms)^Example of medicine prescription formExample of medicine prescription form^Refer to manufacturer’s dosinginstructions or BNF for further advice.NB. Different strengths of inhalers may be slightly different colours to those illustrated.Produced by NHSGGC Medicines Information, September 2013. Endorsed by Respiratory Managed Clinical Network.

Compound Preparations (Corticosteroid/ Long-acting beta 2agonist)FLUTICASONE/FORMOTEROL√Flutiform 125/52 puffs Inhal 01/02/13A N Other (A N OTHER)MDI√√Flutiform ®(aerosol)Strengths^: 50/5 (fluticasone 50 micrograms/formoterol 5 micrograms)125/5 (fluticasone 125 micrograms/formoterol 5 micrograms)250/10 (fluticasone 250 micrograms/formoterol 10 micrograms)Example of medicine prescription form^Refer to manufacturer’s dosinginstructions or BNF for further advice.NB. Different strengths of inhalers may be slightly different colours to those illustrated.Produced by NHSGGC Medicines Information, September 2013. Endorsed by Respiratory Managed Clinical Network.

Spacer DevicesSome patients use spacer devices which remove the need for coordination between actuation of apressurised metered-dose inhaler (MDI) and inhalation. Spacers reduce the velocity of the aerosol andsubsequent impaction on the oropharynx and allow more time for evaporation of the propellant so that alarger proportion of the particles can be inhaled and deposited in the lungs.Spacers should be cleaned once a month and replaced every 6 to 12 months. It is important to prescribe aspacer device that is compatible with the MDI. Spacer devices should not be regarded as interchangeable;patients should be advised not to switch between spacer devices.Volumatic ®• Large-volume device• Compatible with all GlaxoSmithKlinebrand MDIs eg. Ventolin ® , Serevent ® ,Flixotide ® , Seretide ® and also Clenil Modulite ®• Also available with paediatric facemaskProduced by NHSGGC Medicines Information, September 2013. Endorsed by Respiratory Managed Clinical Network.

Spacer DevicesAeroChamber ® PlusAble Spacer ®A2A Spacer ®• Medium-volume device• For use with all pressurised (aerosol) inhalers*• Available as standard device (blue), childdevice (yellow), infant device (orange)• Also available with facemask• Small-volume device• For use with all pressurised(aerosol) inhalers*• Available with infant (small),child (medium) or adult (large) mask• For use with all pressurised 0(aerosol) inhalers*• Available with small ormedium maskOptichamber ® Vortex Spacer ® Pocket Chamber ®• For use with all pressurised 0(aerosol) inhalers*• Available with small, mediumor large mask• Medium-volume device• For use with all pressurised(aerosol) inhalers*• Available with infant, child or adult mask*Please check compatibility of all inhaler devices before prescribing.Flutiform ® has not been tested with all of the spacers listed on this page.• Small-volume device• For use with all pressurised(aerosol) inhalers*• Available with infant, small,medium or large maskProduced by NHSGGC Medicines Information, September 2013. Endorsed by Respiratory Managed Clinical Network.