NHS Lothian DPI Green Inhaler Instructions

NHS Lothian DPI Green Inhaler

Product Information

Specifications

• Abbreviations: DPI, ICS, LABA, LAMA, LRTA, MDI, SABA, MART
• Recommended Usage: Guidance on Inhaled Therapies for Asthma in Adults

Product Usage Instructions

Guidance on Inhaled Therapies for Asthma (Adults)
This guideline is intended to support new patients starting therapy or those needing adjustments in treatment.

Prescription and Inhaler Usage
Inhalers should be prescribed by brand name, except for salbutamol. Combination inhalers should be used when appropriate. Patients should be given a DPI (Dry Powder Inhaler).

Carbon Footprint Indication
An indicator symbol signifies a ‘greener’ choice with regards to  the carbon footprint.

Understanding T2 Low and T2 High Abbreviations
For uncontrolled asthma despite moderate dose ICS/LABA +/LRTA or specific allergen sensitivity, follow the recommendations for T2 low or T2 high asthma.

FAQ
Q: How should I know when to switch inhalers?
A: Inhaler switches should only occur if clinically appropriate after a review by a healthcare professional.

Guidance on Inhaled Therapies: Asthma (Adults)

How to use this guidance

• This guideline should be used to support new patients being commenced on therapy or those requiring treatment to be stepped up or down.
• Inhaler switches should only take place if clinically appropriate after a review.
• Inhalers should be prescribed by brand name, except for salbutamol.
• Combination inhalers should be used where appropriate.

Choosing the right device

• Inhaler technique and adherence should be checked at each review and prior to any treatment escalation.
• Choice of device should be based on individual patient inhaler technique including inspiratory flow rate.
• Can the patient inhale
  • Hard and fast = DPI pathway
  • Slow and steady = MDI pathway (encourage spacer use)
• In this guidance, inhalers are given a symbol indicating required inspiratory flow rate:

Green Inhaler Prescribing

• As part of NHS Scotland’s commitment to greener prescribing, the environmental impact of inhalers has been examined and should be incorporated into prescribing decisions.
• MDIs contain hydrofluorocarbon propellants that are greenhouse gases.
• Over-reliance of salbutamol increases the carbon footprint of a respiratory patient. Therefore, it is essential to identify and treat uncontrolled airways disease, encourage preventer adherence, and ensure inhaler devices are chosen based on individual inhaler technique to optimise control.
• DPIs have lower estimated carbon footprints than MDIs. Therefore, if a patient is able to use both MDI and DPI they should be given a DPI.
• Ventolin® evohalers have higher CO2 emissions than other brands of salbutamol.
• In this guidance inhalers are given a symbol to indicate carbon footprint. This symbol indicates a ‘greener’ choice :

Abbreviations

• DPI Dry Powder Inhaler
• LRTA Leukotriene Receptor Antagonist
• ICS Inhaled Corticosteroid
• MDI Metered Dose Inhaler
• LABA Long-Acting Beta2 Agonist
• SABA Short-Acting Beta2 Agonist
• LAMA Long-Acting Muscarinic Antagonist

MART Maintenance and Reliever Therapy References
Scottish Intercollegiate Guidelines Network (SIGN). SIGN 158: British guideline on management of asthma. Edinburgh: SIGN; 2019. (SIGN publication no. 158). Available from https://www.sign.ac.uk/media/1773/sign158-updated.pdf
Alliance Tech Medical: In-check dial: Inhaler resistance range. Issue number: 3 Available from: In-Check DIAL | Alliance Tech Medical
PrescQIPP Community Interest Company. Lowering the Inhaler Carbon Footprint. Bulletin 295; 2021. Available from: Respiratory care | PrescQIPP C.I.C

Guidance on Inhaled Therapies: Asthma (Adults

STOP. THINK. REVIEW.

• Check inhaler technique/adherence
• Manage co-morbidities/review triggers
• Consider smoking status/smoking cessation
• Lifestyle and exercise
• Consider self-management advice

Produced by NHS Lothian Respiratory Managed Clinical Network. This guidance is supplementary to the East Region Formulary, please visit the ERF for the most up to date information. Feb 2024 V4 / Review Feb 2025.

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