NEL Adult Respiratory Inhaler Formulary July 2023
This formulary has been developed with stakeholders across NEL to support consistent high quality respiratory care when used in conjunction with the NEL adult asthma and COPD guidelines. The list includes associated carbon footprint and device type listed alongside with links to the product specifications and video links for inhaler technique demonstrations. Please prescribe only by Brand and Device.
All Dry Powder Inhalers (DPIs) have lower carbon footprint but require patients to have a deep and fast inspiratory effort technique to use them optimally.
Metered Dose Inhalers (MDIs) currently have a higher carbon footprint due to the propellent used in MDI canisters. MDI devices however will be suitable for patients who are unable to take deep and fast inspiratory breaths rendering DPI devices unsuitable. MDI and Soft Mist Inhalers (SMI) devices require a slow steady breath to inhale their medication optimally. Use an In-check Device to assess if unable to make an assessment as recommended in both the adult asthma and COPD guidelines. A spacer can optimise inhaler technique and enhance drug deposition when used together with MDIs.
Consider prescribing combination inhalers instead of separate monotherapies to improve adherence in addition to being more cost effective and lower in carbon footprint.
When separate inhalers are required, select devices that require the same inspiratory technique for the patient to optimise their technique.
Note that inhalers with very high carbon footprint such as Flutiform MDI and Symbicort MDI have been made non-formulary across NEL for adults as there are lower carbon MDIs available within their class of inhalers.
Patients who are currently stable on any non-formulary inhalers should not be switched without a face-to-face consultation. All patients should be reviewed and be part of a shared decision-making consultation before any changes to inhaler prescribing takes place. No mass switching of inhalers will be allowed across NEL.