Paediatric asthma formulary pathway

*Consider carbon footprint of inhalers: MDI higher than DPI, Optimise therapy and check inhaler technique*

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Step 1 - Regular very low dose inhaled steroid

Formulary Choices:
Soprobec 50mcg 2 puffs BD (£1.66) - MDI (licensed from age 2)
Budesonide Easyhaler 100mcg 1 puff BD (£2.65) - DPI (licensed from age 6)
Budesonide (Pulmicort) turbohaler 100mcg 1 puff BD(£4.27) - DPI (licensed from age 5)

Equivalents - Non Formulary:
Clenil 50mcg 2 Puffs BD (£2.22) - MDI equivalent to Soprobec (licensed from age 2)
Flixotide 50mcg evohaler 1 puff BD (£2.72) - MDI (licensed from age 2)
Flixotide 50mcg 1 puff BD accuhaler (£4.00) - DPI (licensed from age 5)

Step 2 – Add regular long acting beta agonist (LABA) – Or montelukast for <5s

Formulary Choices:
Swap to Seretide 50mcg evohaler 1 puff BD (£8.73) - MDI (licensed from age 5)
Swap to Symbicort 100/6 1 puff BD (£14.00) - DPI (licensed from age 6)

Equivalents - Non Formulary:
Add Serevent 25mcg Evohaler 2 puffs BD (£29.26) - MDI (licensed from age 5)
Add Easyhaler Formoterol 12mcg 1 puff BD (£23.75) - DPI (licensed from age 6)

Step 3 – Increase to low dose inhaled steroid

Formulary Choices:
Seretide 50/25 evohaler 2 puffs BD (£17.46) - MDI (licensed from age 5)
DuoResp Spiromax 160/4.5 1 puff BD (£13.98) - DPI (licensed from age 12)
Seretide 100/50 Accuhaler 1 puff BD (£17.46) - DPI (licensed from age 5)

Equivalents - Non Formulary:
LABA + Pulmicort turbohaler 100mcg 2 puffs BD (£8.55) - DPI (licensed from age 5)
LABA + Clenil 100mcg 2 puffs BD (£4.45) - MDI (licensed from age 2)
LABA + Budesonide 100mcg Easyhaler 2 puffs BD (£5.32) - DPI (licensed from age 6)
Symbicort 100/6 turbohaler 2 puffs BD (£28.00) - DPI (licensed from age 6)
Flutiform 50mcg 2 puffs BD (£14.40) - DPI (licensed from age 12)

Step 4 – Trial of Montelukast 4mg OD (5mg from age 6)

Step 5 – Refer for review before increasing to medium dose steroid

Formulary Choices:
Seretide 125/25 Evohaler 2 puffs BD (£23.45) - MDI (licensed from age 12)
DuoResp Spiromax 160/4.5 2 puffs BD (£27.97) - DPI (licensed from age 12)
DuoResp Spiromax 320/9 1 puff BD (£27.97) - DPI (licensed from age 12)

Equivalents - Non Formulary:
LABA + Pulmicort turbohaler 200mcg 2 puffs BD (£17.10) - DPI (licensed from age 12)
LABA + Clenil 200mcg 2 puffs BD (£9.70) - MDI (licensed from age 12)
LABA + Budesonide 200mcg Easyhaler 2 puffs BD (£10.62) - DPI (licensed from age 6)
Symbicort 200/6 turbohaler 2 puffs BD (£28.00) - DPI (licensed from age 12)
Flutiform 125mcg 2 puffs BD (£28.00) - DPI (licensed from age 12)
Fusacomb 50/250 Easyhaler 1 puff BD (£21.50) - DPI (licensed from age 12)

Reliever as required – Consider step up if using 3 doses a week or more

Formulary Choice:
Salbutamol MDI 2 puffs as required(£1.50); Salamol Easi-Breathe MDI (£6.30)

Notes

Note Kelhale, Qvar, Luforbec, Fostair, Flixotide, Flutiform, Seretide and Asmanex are ‘double strength’ compared to standard Beclometasone. Costs for 30 days

Last reviewed: 30/10/2023

Next review date: 30/10/2025

Author(s): Emily Kennedy.

Version: 1