London Respiratory Team
Responsible Respiratory Prescribing – Key messages
1. 3 out of the top 5 drugs in terms of total spend to the NHS are respiratory inhalers
Doing the right thing:
2. When prescribing any new respiratory inhaler, ensure that the patient has undergone
NICE-recommended support to stop smoking
3. If prescribing triple therapy for COPD (LABA+LAMA+ICS), ensure that the patient has
been referred for pulmonary rehabilitation
Doing things right:
4. When prescribing any inhaled medication, ensure that the patient has undergone patient
centred education about the disease and inhaler technique training by a competent trainer
5. When prescribing an MDI (except salbutamol), ensure that a spacer is also prescribed and
will be used
6. When prescribing high dose inhaled corticosteroids (>1000ug BDP equivalent?), ensure that
the patient is issued a steroid safety card
7. Prednisolone EC should not be prescribed over plain Prednisolone without good clinical
1. It is not widely known that respiratory medications constitute 3 of the top 5 drugs in terms of total
spend in the NHS, and that respiratory medications have the highest average cost per item.
2. Around 50% of COPD patients continue to smoke at diagnosis, and stopping smoking is THE most cost
effective treatment in the management of COPD
3. There is strong evidence that pulmonary rehabilitation is more effective than drug treatment in the
management of COPD at MRC breathlessness stage 3 and above
4. Many COPD patients are confused about their medications and unable to use their inhalers effectively.
Also, many healthcare professionals are unclear about inhaler technique. Thus it is important that
patients receive good education from someone who has been trained to do so.
5. Combination metered dose inhalers are very expensive. Many patients cannot use a metered dose
effectively and would benefit from using a spacer device. Even in those with good technique, a spacer
will increase the amount of drug being delivered into the lungs which would potentially improve their
6. High doses of inhaled corticosteroids (>1000ug BDP equivalent) have been associated with increased risk
of pneumonia, diabetes, skin thinning and osteoporosis. If such high doses are necessary, the benefits
and risks should be explained to the patient, and they should be issued with a steroid safety card.
7. Enteric coated prednisolone does not confer gastric protection, is no more effective and is expensive.
For further information please contact the Responsible Respiratory Prescribing Clinical Lead :
Dr Vince Mak at: firstname.lastname@example.org
Commissioning Support for London
Stephenson House, 75 Hampstead Rd, London NW1 2PL