Chapter 3: Respiratory system

Assess symptom control (SIGN 153 recommends : ask about frequency of inhaler use/adherence)

Effectiveness

Assess inhaler technique and adherence to dosing schedule

Also see NHS Scotland Respiratory Prescribing Strategy

Adherence/Patient centeredness

Monotherapy in COPD is not appropriate - safer, more effective alternatives are available.

Need

CAUTION: Toxicity (tachycardia, CNS excitation).
Avoid combination with macrolides and quinolones.

Safety

Long term oral use for respiratory disease is rarely indicated

• Withdraw gradually if: use >3 weeks, >40 mg prednisolone/d
• When stepping down use of steroid inhalers: Reduce dose slowly (by 50% every 3 months)

Need

CAUTION: Osteoporotic fractures: Consider bone protection if long term treatment necessary

Ensure use of steroids aligned with COPD GOLD guideline

Safety

Rarely indicated long term

Need

CAUTION: Anticholinergic ADRs. See Anticholinergics

Safety