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Bedfordshire and Luton Joint Formulary
Bedfordshire Hospitals NHS Foundation Trust
Bedfordshire, Luton and Milton Keynes ICB
Formulary Chapter: 3 - Respiratory system 
Notes:

Any drug not listed on the Formulary should be considered Non-Formulary - Not recommended for prescribing
Links:
BLMK ICB Guidance: Chronic obstructive pulmonary disease guidelines for primary care BLMK ICB Guidance: Review of Inhaled Corticosteroids (ICS) in patients with COPD BLMK Paediatric Wheeze and Asthma Guidelines (Children Age 16 and under), Oct 2024 NICE NG115: COPD guideline NICE NG78: Cystic fibrosis: diagnosis and management. October 2017 Right Breathe Inhaler Prescribing Information
03.01.02 Antimuscarinic bronchodilators

Tiotropium (Braltus)

GREEN
First Choice

Long-acting muscarinic antagonist.

  • Braltus® (tiotropium)  DPI - Dry Powder InhalerGreen Footprint
  • Braltus 10 micrograms delivered dose inhalation powder hard capsule (Zonda Inhaler device).Green Footprint

Branded generic equivalent to Spiriva.

Notes:
First line most cost effective choice.
Each capsule contains 16 micrograms of tiotropium bromide equivalent to 13 micrograms of tiotropium. The delivered dose (the dose that leaves the mouthpiece of the Zonda inhaler) is 10micrograms of tiotropium per capsule.
Each patient should be issued a new Zonda inhaler and capsules every 30 days; old inhalers should be discarded.
Braltus Zonda inhaler delivers the same dose of Tiotropium as Spiriva HandiHaler (18 micrograms – delivered dose of 10 micrograms)

 

Entry reviewed: September 2022

BNF BNFc SPC
Braltus (tiotropium): risk of inhalation of capsule if placed in the mouthpiece of the inhaler

Aclidinium (Eklira Genuair®)

GREEN
Second Choice

Long-acting muscarinic antagonist - LAMA


322micrograms per metered dose - Inhalation powderGreen Footprint

 

Entry Reviewed: September 2022

BNF BNFc SPC

Spiriva 2.5 microgram Respimat

GREEN
Second Choice

Long-acting muscarinic antagonist - LAMA Green Footprint

Asthma: As per BLMK guidelines.  If asthma uncontrolled on moderate dose MART consider 8-12 week trial of Montelukast or Spiriva Respimat (more helpful if element of fixed airways obstruction).

Entry Reviewed: November 2025

BNF BNFc SPC

Glycopyrronium (Seebri breezhaler®)

GREEN
Formulary

Long Acting Muscarinic Antagonist - LAMA

Inhalation powder, hard capsule, (for use with Seebri Breezhaler® device), 50 micrograms.Green Footprint

 

Entry Reviewed: September 2022

BNF BNFc SPC

Ipratropium 20 microgram
(MDI Inhaler)

GREEN
Formulary

Short-acting muscarinic antagonist- SAMA Red Footprint

 

Entry Reviewed: September 2022

BNF BNFc SPC

Tiotropium inhalation
(For asthma)

Amber SPA
Formulary

Long-acting muscarinic antagonist (LAMA)

  • 2.5micrograms per metered dose - inhaler (Respimat)  Green Low Carbon

          Only Respimat® device is licensed for asthma

  • 18 microgram inhaler (Tiogiva®) Green Low Carbon

Entry reviewed: October 2024

BNF BNFc SPC

Tiotropium inhalation
(for COPD)

GREEN
Formulary

Long-acting muscarinic antagonist (LAMA)

  • 2.5micrograms per metered dose - inhaler (Respimat)  Green Low Carbon

          Only Respimat® device is licensed for asthma

  • 18 microgram inhaler (Tiogiva®) Green Low Carbon

Entry reviewed: October 2024

BNF BNFc SPC

Umeclidinium (Incruse Ellipta®)

GREEN
Formulary

 Long acting muscarinic antagonistGreen Low Carbon

 

 

 

Entry reviewed: September 2022

BNF BNFc SPC
Classifications
GREEN
May be initiated in any care setting
Amber SPA
Specialist to advise therapy and provide first 28 days supply, continuation in Primary Care
Amber SPIS
Specialist to initiate and stabilise medicine prior to continuation in Primary Care
SCG
To be prescribed as per Shared Care Guidance. If no SCG in place status reverts to red.
RED
Red medicines are designated as specialist only medicines which should only be prescribed by a specialist, usually within secondary care (either due to the requirement for specialist knowledge, long-term monitoring requirements, or restrictions that mean medicine supplies are only available to hospitals).
DNP
A decision has been made either locally and/or nationally not to routinely commission this preparation. Do not prescribe.
SELF
To be purchased over the counter. May be prescribed for chronic, long term conditions or on admission to hospital if essential.