3.2 Corticosteroids

High dose MDI inhaled corticosteroid devices should be prescribed with a spacer to reduce risk of oral candidiasis.

For information on inhaled corticosteroid dose comparisons in asthma see here

In the absence of a clinical or dexterity reason for the choice of inhaler, the product which has the cheapest acquisition cost should be chosen.

Generic prescribing of inhalers should be avoided as this might lead to people with asthma being given an unfamiliar inhaler device which they are not able to use properly; in addition, not all inhalers with the same primary ingredient are interchangeable due to differences in particle size.

Different products and doses are licensed for different age groups and some may be applicable only to older children or adults (aged 18 years and over). Prior to prescribing, the relevant summary of product characteristics (SPC) should be checked.

Advice on how to obtain placebo inhalers can be obtained from the NEW Devon CCG Medicines Optimisation Team, please contact: d-ccg.medicinesoptimisation@nhs.net

MDI = Metered dose inhaler; DPI = Dry powder inhaler; Beclometasone dipropionate = BDP

When prescribing a pressurised MDI, remind patients to check and remove the mouthpiece cover properly before inhaling a dose and to shake the inhaler to remove loose objects that may have become trapped in the inhaler during storage. The mouthpiece cover should be replaced securely after use. See MHRA Drug Safety Alert July 2018 for further details

Clenil® Modulite

(BDP)

  • Aerosol inhalation 50 micrograms/ metered inhalation, 100 micrograms/ metered inhalation, 200 micrograms/ metered inhalation, 250 micrograms/ metered inhalation (MDI) (£16.17 = 200 micrograms x 200 doses)

Indications and dose

Notes

  1. BDP inhalers should be brand prescribed since they are not interchangeable. Qvar® is an extrafine particle formulation and is approximately twice as potent as Clenil® Modulite®
  2. Clenil® Modulite® 200 and 250 are not recommended for use in children
Qvar®

(BDP extrafine)

  • Aerosol inhalation 50 micrograms/ metered inhalation, 100 micrograms/ metered inhalation (MDI) (£17.21 = 100 micrograms x 200 doses)
  • Autohaler® breath-actuated aerosol inhalation 50 micrograms/ metered inhalation, 100 micrograms/ metered inhalation (MDI) (£17.21 = 100 micrograms x 200 doses)
  • Easi-breathe® breath-actuated aerosol inhalation 50 micrograms, 100 micrograms/ metered inhalation (MDI) (£19.95 = 100 micrograms x 200 doses)

Indications and dose

Notes

  1. BDP inhalers should be brand prescribed since they are not interchangeable. Qvar® is an extra-fine particle formulation and is approximately twice as potent as Clenil® Modulite®
  2. Qvar ® is not licensed for use in children under 12 years.
Budesonide
  • Pulmicort® Turbohaler® dry powder inhaler 100 micrograms/ metered inhalation, 200 micrograms/ metered inhalation, 400 micrograms/ metered inhalation (DPI) (£14.25 = 200 micrograms x 100 doses)
  • Nebuliser solution 250 micrograms/mL, 500 micrograms/mL (£39.00 = 500 micrograms/ml, 20 x 2ml)

Indications and dose

Notes

  1. Refer to BNF or manufacturer'sSummary of Product Characteristics (SPC) for once daily dosing regimen

 

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