Respiratory system

Dorset COPD treatment guideline

 

 

3.1.1 Selective beta2 agonists 

First line short-acting beta2 agonists: salbutamol

Alternative: terbutaline

Flutiform® commissioning statement

First line long-acting beta2 agonists:  indacaterol

Alternative: formoterol, salmeterol

For hospital use only: salbutamol iv, terbutaline iv

3.1.2 Antimuscarinic bronchodilators

Short acting option: ipratropium

Long acting option: tiotropium, glycopyrronium bromide (Seebri Breezhaler®)

3.1.3 Theophylline

First line: theophylline m/r, aminophylline m/r (prescribe by brand)

For hospital use only: aminophylline iv

For use in NICU/SCBU only: caffeine injection

3.1.4 Compound bronchodilator preparations
N.B. less suitable for prescribing

First line: Ipratropium and salbutamol nebules

3.1.5 Peak flow meters, inhaler devices and nebulisers

First line spacer options: Aerochamber®, Nebuchamber®, Vortex®, Volumatic®

First line peak flow meter options: MiniWright®, Vitalograph®

3.2 Corticosteroids

First line: beclometasone - please prescribe by brand

Alternatives: budesonide, ciclesonide (not at DCH), fluticasone

Compound preparations: Fostair®, Seretide®, Symbicort®

3.3.1 Cromoglicate and related therapy

First line: Sodium cromoglicate

3.3.2 Leukotriene receptor antagonists

First line: montelukast

3.4.1 Antihistamines

Non-sedating first line options: cetirizine, loratidine

For dermatology use only: fexofenadine

Sedating first line: chlorphenamine

Sedating alternatives: hydroxyzine, promethazine, alimemazine

3.4.2 Allergen immunotherapy

For hospital use only: omalizumab

3.4.3 Allergic emergencies

First line: adrenaline (epinephrine)

For hospital use only: C1 esterase inhibitor

3.5.1 Respiratory stimulants

For hospital use only: doxapram

3.5.2 Pulmonary surfactants

For hospital use only: beractant, poractant alfa

3.7.1 Mucolytics

Carbocisteine

For hospital initiation: dornase alfa

For hospital use only: hypertonic sodium chloride nebuliser solution 7%, mannitol dpi (Bronchitol®)

NICE TA 266 mannitol

3.8 Aromatic inhalations

For hospital use only: benzoin compound tincture

3.9.1 Cough suppressants

First line options: codeine, pholcodine

For palliative care use only: methadone linctus

3.9.2 Demulcent and expectorant cough preparations

Simple linctus

3.10 Systemic nasal decongestants

Pseudoephedrine