Respiratory Inhalers

Identification Guide
Version 2

This booklet has been produced by NHS Greater Glasgow and Clyde together with the following companies,
Almirall, AstraZeneca, Boehringer Ingelheim Ltd, Chiesi, GSK, Napp and Novartis as a service to medicine.
Endorsed by NHSGGC Respiratory Managed Clinical Network, September 2013
230801 Designed by Medical Illustration Services
Produced by NHSGGC Medicines Information, September 2013. Endorsed by Respiratory Managed Clinical Network.
CONTENTS
Example Costs of Respiratory Inhaler Devices
Recommendations for Inhaler Supply
Respiratory Inhaler Identification
• Short-acting beta2 agonist inhalers (SABAs) Salbutamol
Terbutaline

• Long-acting beta2 agonist inhalers (LABAs) Salmeterol
Formoterol
Indacaterol

• Short-acting muscarinic antagonists (SAMAs) Ipratropium

• Long-acting muscarinic antagonists (LAMAs) Tiotropium
Aclidinium
Glycopyrronium

• Corticosteroid inhalers Beclometasone

Fluticasone
Budesonide

• Compound preparations Seretide®
Symbicort®
Fostair®
Flutiform®

Spacer Devices
Examples of High Cost Respiratory Inhaler Devices
Some inhaler devices are relatively more expensive than others. Examples of some of the higher cost devices
are provided below. (Costs from eMIMS May 2013)

Seretide Accuhaler® Seretide Evohaler® Symbicort Turbohaler® Spiriva®

250 strength (60 doses) £35 125 strength (120 doses) £35 200/6 strength (120 doses) £38 cap pack with HandiHaler®
500 strength (60 doses) £40.92 250 strength (120 doses) £59.48 400/12 strength (60 doses) £38 device £34.87
30 cap refill £33.50

NB. For patients on Seretide® 500

micrograms twice daily, the 250
evohaler® is more expensive than
the equivalent 500 accuhaler®

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Recommendations for Inhaler Supply

** Important points to consider before issuing or prescribing inhalers **

• Approximately £1.5 million� was spent in 2012/13 on inhalers within NHSGGC Acute care. A lot of inhaler wastage
occurs across NHSGGC Acute and most would be considered preventable.
• By adhering to the following recommendations, inhaler wastage could be minimised. Patient safety would also be
improved by ensuring patients receive the correct inhaler, strength and device during hospital admission.
• Encourage the use of patient’s own inhalers.
• Always ask patients if they have their own inhaler(s) before ordering or issuing a new inhaler. If patients have their
own inhaler(s), check the expiry date and if it is the current inhaler prescribed by the GP. If they don’t have
their inhaler, ask if a relative or carer could bring it in at their earliest convenience.
• If a patient is transferred to another ward, ensure inhaler(s) are transferred with the patient. Similarly, if a patient
has been transferred from another ward, always check if they have been issued with inhaler(s) prior to transfer.
• Always check what type of inhaler device and strength the patient uses before ordering or issuing a new one. If
unsure, discuss with the doctor, clinical pharmacist, or respiratory nurse specialist.
• Ensure the correct device is clearly prescribed on the medicine prescription form (e.g. Accuhaler®, turbohaler®,
evohaler®) prior to administration.
• Always check if a patient has an inhaler before documenting code ‘13’ (patient self administration) on the medicine
prescription form. Do not assume that patients have their own inhalers and they are using them as prescribed.
• When patients are started on inhalers for the first time, inhaler technique should be assessed. Seek advice from
pharmacy or respiratory nurse specialist if unsure of the most suitable device.

** Stop and think before ordering, issuing or prescribing inhalers ** �

(costs from Ascribe business objects acute database)

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Respiratory Inhaler Identification

There are many different inhaler devices available. Examples of the different types of inhaler devices
are illustrated to aid identification. Please note however, that different strengths of inhalers may be
slightly different colours than those shown. The manufacturer’s packaging may also differ from time
to time.The following images are for illustrative purposes only. If the patient does not have any of the
inhaler devices illustrated, and you are unsure what device the patient normally uses, please speak to
a pharmacist or respiratory nurse specialist for further advice.

This booklet is not intended to be a prescribing guide. Although dosage information is provided for
some preparations, always refer to the BNF or manufacturer’s Summary of Product Characteristics
(SPC) for current dosage advice and further information.

The examples of the medicine prescription forms (kardexes) are for illustrative purposes only and do
not reflect all doses available for each inhaler preparation.

The Asthma UK website has useful information on how to use spacers and different inhaler devices.
Refer to the link below to access videos on inhaler technique:
http://www.asthma.org.uk/knowledge-bank-treatment-and-medicines-using-your-inhalers

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Bronchodilator – short-acting beta2 agonist (blue/reliever) Inhalers (SABAs)
SALBUTAMOL

Adult Dose
By aerosol inhalation
100-200 micrograms; for persistent
symptoms up to 4 times daily. Refer
to manufacturer’s dosing instructions
or BNF for further advice.

Salbutamol Salamol Airomir Salbutamol 100 micrograms

*MDI (aerosol) Easi-Breathe® Autohaler® √

2 puffs Inhal SOB/wheeze

(brands include (aerosol) (aerosol) A N Other (A N OTHER)

4x 01/02/13

Ventolin evohaler®)
day

Ventolin evohaler

Strength: 100 micrograms/ Strength: 100 micrograms/ Strength: 100 micrograms/

metered inhalation metered inhalation metered inhalation Example of medicine prescription form

(*MDI = metered-dose inhaler)

NB. Different strengths of inhalers may be slightly different colours to those illustrated.

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Bronchodilator – short-acting beta2 agonist (blue/reliever) Inhalers (SABAs)
SALBUTAMOL

Pulvinal® Easyhaler® Asmasal Ventolin

Salbutamol Salbutamol Clickhaler® Accuhaler®
(dry powder) (dry powder) (dry powder) (dry powder)
Strength: 200 Strengths: 100, 200 Strength: 95 Strength: 200
micrograms/ micrograms/ micrograms/ micrograms/
metered inhalation^ metered inhalation^ metered inhalation^ metered inhalation^

^Refer to manufacturer’s dosing
instructions or BNF for further Salbutamol 200 micrograms

advice. √
1 puff Inhal SOB/wheeze

4x 01/02/13
A N Other (A N OTHER) day

Ventolin accuhaler

Example of medicine prescription form

NB. Different strengths of inhalers may be slightly different colours to those illustrated.

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Bronchodilator – short-acting beta2 agonist (blue/reliever) Inhalers (SABAs)
TERBUTALINE SULPHATE
Adult Dose
By inhalation of powder
500 micrograms; for persistent symptoms
up to 4 times daily. Refer to manufacturer’s
dosing instructions or BNF for further advice.

Terbutaline 500 micrograms

√
Bricanyl 1 puff Inhal SOB/wheeze

Turbohaler® A N Other (A N OTHER)

4x
day
01/02/13

(dry powder) Bricanyl turbohaler

Strength: 500
micrograms/metered inhalation Example of medicine prescription form

NB. Different strengths of inhalers may be slightly different colours to those illustrated.

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Long-acting beta2 agonist Inhalers (LABAs)
SALMETEROL

Serevent Serevent Diskhaler® Serevent Neovent®

Accuhaler
®
(dry powder) Evohaler® MDI (aerosol)
(dry powder) MDI (aerosol) Strength: 25 micrograms/
Strength: 50 micrograms/blister
Strength: 50 micrograms/metered Strength: 25 micrograms/ metered inhalation
inhalation metered inhalation
Adult Dose Adult Dose
By inhalation of dry powder By aerosol inhalation
50 micrograms twice daily; 50 micrograms twice daily; up to
up to 100 micrograms twice daily. 100 micrograms twice daily.
Refer to manufacturer’s dosing Refer to manufacturer’s dosing
instructions or BNF for further advice. instructions or BNF for further advice.

Salmeterol 50 micrograms
Salmeterol 25 micrograms
√ √ √ √
1 puff Inhal 01/02/13 2 puffs Inhal 01/02/13

A N Other (A N OTHER) A N Other (A N OTHER)

Serevent accuhaler
√ Serevent evohaler
√

Example of medicine prescription form Example of medicine prescription form

NB. Different strengths of inhalers may be slightly different colours to those illustrated.
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Long-acting beta2 agonist Inhalers (LABAs)
FORMOTEROL FUMARATE

Oxis Easyhaler® Formoterol Atimos Modulite®

Turbohaler® (dry powder) (aerosol)
(dry powder) Strength: 12 micrograms/metered inhalation^
Strength: 12 micrograms/metered
Strengths^: 6, 12 micrograms/ inhalation^
metered inhalation

Formoterol 12 micrograms
^Refer to manufacturer’s dosing √ √
1 puff Inhal
instructions or BNF for further advice.
01/02/13

A N Other (A N OTHER)

Oxis turbohaler

Example of medicine prescription form

NB. Different strengths of inhalers may be slightly different colours to those illustrated.

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Long-acting beta2 agonist Inhalers (LABAs)
INDACATEROL
Adult Dose:
By inhalation of dry powder
150 micrograms once daily,
increased to max. 300
Indacaterol
micrograms once daily. √ √
Refer to manufacturer’s 150 micrograms Inhal 01/02/13

dosing instructions or BNF A N Other (A N OTHER)

for further advice. Onbrez breezhaler

Onbrez Breezhaler® Example of medicine prescription form

(inhalation powder, hard capsule)

Strengths: 150, 300 micrograms/metered inhalation

NB. Different strengths of inhalers may be slightly different colours to those illustrated.

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Antimuscarinic Bronchodilator Inhalers – short-acting muscarinic antagonists (SAMAs)

IPRATROPIUM BROMIDE

Adult Dose
By aerosol inhalation
20-40 micrograms 3-4
times daily. Refer to Ipratropium bromide 20 micrograms

manufacturer’s dosing √
2 puffs Inhal √
√
01/02/13

instructions or BNF for A N Other (A N OTHER) √

further advice. Atrovent MDI

Atrovent ® Example of medicine prescription form

MDI (aerosol)
Strength: 20 micrograms/metered inhalation

NB. Different strengths of inhalers may be slightly different colours to those illustrated.

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Antimuscarinic Bronchodilator Inhalers – long-acting muscarinic antagonists (LAMAs)

TIOTROPIUM

Adult Dose
By inhalation of powder
18 micrograms once daily. Tiotropium
√ √
Refer to manufacturer’s 18 micrograms Inhal 01/02/13

dosing instructions or A N Other (A N OTHER)

BNF for further advice. Spiriva Handihaler

Spiriva
®
Example of medicine prescription form
(inhalation powder, hard capsule
for use with HandiHaler® device)
Strength: 18 microgram cap

Adult dose
By inhalation
5 micrograms (2 puffs)
once daily. Refer to Tiotropium 2.5 micrograms
√
manufacturer’s dosing 2 puffs Inhal 01/02/13 √
instructions or BNF for A N Other (A N OTHER)
further advice. Spiriva Respimat

Example of medicine prescription form

Spiriva Respimat®
(solution for inhalation) Please note. Spiriva Respimat is currently non-formulary in NHSGGC.
Strength: 2.5 micrograms/
metered inhalation

NB. Different strengths of inhalers may be slightly different colours to those illustrated.
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Antimuscarinic Bronchodilator Inhalers – long-acting muscarinic antagonists (LAMAs)

ACLIDINIUM BROMIDE

Adult Dose
By inhalation of dry powder Aclidinium 322 micrograms
1 inhalation twice daily. √
1 puff Inhal
√
01/02/13

Refer to manufacturer’s dosing A N Other (A N OTHER)

instructions or BNF for further advice. Eklira Genuair
√

Example of medicine prescription form

Eklira Genuair®
(dry powder)
Strength: 400 micrograms/metered inhalation

Equivalence: each 400 micrograms metered

inhalation of aclidinium bromide delivers 375
micrograms of aclidinium bromide which is
equivalent to 322 micrograms of aclidinium.

NB. Different strengths of inhalers may be slightly different colours to those illustrated.

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Antimuscarinic Bronchodilator Inhalers – long-acting muscarinic antagonists (LAMAs)
GLYCOPYRRONIUM

Adult Dose
By inhalation of powder
50 micrograms
once daily. Refer to
manufacturer’s dosing Glycopyrronium
√ √
instructions or BNF for 50 micrograms Inhal 01/02/13

further advice. A N Other (A N OTHER)

Seebri Breezhaler

Example of medicine prescription form

Seebri Breezhaler®
(inhalation powder, hard capsule)
Strength: 50 micrograms cap

Equivalence: each 50 microgram capsule

of glycopyrronium delivers 44 micrograms
of glycopyrronium

NB. Different strengths of inhalers may be slightly different colours to those illustrated.

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Corticosteroid (brown/preventer) Inhalers
BECLOMETASONE DIPROPIONATE
** NOTE:
BECLOMETASONE CFC-FREE AEROSOL INHALERS ARE NOT INTERCHANGEABLE AND MUST BE PRESCRIBED BY BRAND NAME **

Adult Dose
By aerosol inhalation
200-400 micrograms twice
daily (up to 1mg twice daily) Clenil modulite 100 micrograms
√ √
Refer to manufacturer’s 2 puffs Inhal 01/02/13

dosing instructions or BNF for A N Other (A N OTHER)

further advice. MDI

√

Example of medicine prescription form

Clenil Modulite®
(CFC-free) MDI (aerosol)
Strengths: 50, 100, 200, 250 micrograms/
metered inhalation

NB. Different strengths of inhalers may be slightly different colours to those illustrated.

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Corticosteroid (brown/preventer) Inhalers
BECLOMETASONE DIPROPIONATE

** NOTE:
BECLOMETASONE CFC-FREE AEROSOL INHALERS ARE NOT INTERCHANGEABLE AND MUST BE PRESCRIBED BY BRAND NAME **

Adult Dose
By aerosol inhalation
50-200 micrograms twice
daily (up to 400 micro-
grams twice daily). Refer
to manufacturer’s dosing
instructions or BNF for
Qvar® Qvar Autohaler® Qvar Easi-Breathe® further advice.
(CFC-free) MDI (aerosol) (aerosol) (aerosol)
Strengths: 50, 100 micrograms/
Strengths: 50, 100 micrograms/ Strengths: 50, 100 micrograms/ metered inhalation
metered inhalation metered inhalation

Qvar 100 micrograms

√ √
1 puff Inhal 01/02/13

A N Other (A N OTHER)

MDI
√

Example of medicine prescription form

NB. Different strengths of inhalers may be slightly different colours to those illustrated.

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Corticosteroid (brown/preventer) Inhalers
BECLOMETASONE DIPROPIONATE

Beclometasone 200 micrograms
√ √
1 puff Inhal 01/02/13

A N Other (A N OTHER)

Dry powder inhaler (Easyhaler)

√

Pulvinal® Easyhaler® Asmabec Example of medicine prescription form

Beclometasone Beclometasone Clickhaler®
(dry powder) (dry powder) (dry powder)
Strengths^: 100, 200, Strength^: 200 Strengths^: 100, 250
400 micrograms/ micrograms/ micrograms/metered
metered inhalation metered inhalation inhalation^

^Refer to manufacturer’s dosing

instructions or BNF for further advice.

NB. Different strengths of inhalers may be slightly different colours to those illustrated.

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Corticosteroid (brown/preventer) Inhalers
FLUTICASONE PROPIONATE

Adult Dose
Adult Dose
By aerosol inhalation By inhalation of dry powder
100-500 micrograms twice 100-500 micrograms twice
daily (up to 1mg twice daily) daily (up to 1mg twice daily)
Refer to manufacturer’s Refer to manufacturer’s
dosing instructions or BNF dosing instructions or BNF
for further advice. for further advice.

Flixotide Flixotide
Evohaler® Accuhaler®
MDI (aerosol) (dry powder)
Strengths: 50, 125, 250 Strengths: 50, 100, 250, 500
micrograms/metered micrograms/metered
inhalation inhalation

Fluticasone 125 micrograms Fluticasone 250 micrograms

√ √ √ √
2 puffs Inhal 01/02/13 1 puff Inhal 01/02/13

A N Other (A N OTHER) A N Other (A N OTHER)

Flixotide evohaler
√ Flixotide accuhaler
√

Example of medicine prescription form Example of medicine prescription form

NB. Different strengths of inhalers may be slightly different colours to those illustrated.
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Corticosteroid (brown/preventer) Inhalers
BUDESONIDE

Pulmicort Easyhaler ®
budesonide Budelin novolizer®
® (dry powder)
Turbohaler (dry powder)
(dry powder)
Strengths^: 100, 200, 400 micrograms/ Strength: 200 micrograms/metered inhalation^
metered inhalation
Strengths^: 100, 200, 400
micrograms/metered inhalation

^Refer to manufacturer’s dosing
Budesonide 200 micrograms
instructions or BNF for further advice. √ √
1 puff Inhal 01/02/13

A N Other (A N OTHER)

Pulmicort turbohaler
√

Example of medicine prescription form

NB. Different strengths of inhalers may be slightly different colours to those illustrated.

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Compound Preparations (Corticosteroid/ Long-acting beta2 agonist)
FLUTICASONE/SALMETEROL

Seretide Seretide
Accuhaler® Evohaler®
(dry powder) MDI (aerosol)
Strengths^: Strengths^:
100 Accuhaler® 50 Evohaler®
(fluticasone 100 micrograms/salmeterol 50micrograms) (fluticasone 50 micrograms/salmeterol 25micrograms)
250 Accuhaler® 125 Evohaler®
(fluticasone 250 micrograms/salmeterol 50micrograms) (fluticasone 125 micrograms/salmeterol 25micrograms)
500 Accuhaler® 250 Evohaler®
(fluticasone 500 micrograms/salmeterol 50micrograms) (fluticasone 250 micrograms/salmeterol 25micrograms)

^Refer to manufacturer’s
Seretide 500 accuhaler dosing instructions or BNF Seretide 250 evohaler
√ √ √ √
1 puff Inhal 01/02/13 for further advice. 2 puffs Inhal 01/02/13

A N Other (A N OTHER) A N Other (A N OTHER)

√ √

Example of medicine prescription form Example of medicine prescription form

NB. Different strengths of inhalers may be slightly different colours to those illustrated.
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Compound Preparations (Corticosteroid/ Long-acting beta2 agonist)
BUDESONIDE/FORMOTEROL

Symbicort Maintenance Therapy Symbicort Reliever Therapy

Symbicort 200/6
Symbicort 200/6 turbohaler √
√ √ 1 puff Inhal SOB/wheeze
2 puffs Inhal 01/02/13

8x 01/02/13
A N Other (A N OTHER) A N Other (A N OTHER) day
√ Max. 6 puffs on any one occasion

Example of medicine prescription form Example of medicine prescription form

Symbicort Turbohaler®
(dry powder)
Strengths^:
100/6 Turbohaler® (budesonide 100 micrograms/formoterol 6micrograms)
200/6 Turbohaler® (budesonide 200 micrograms/formoterol 6micrograms)
400/12 Turbohaler® (budesonide 400 micrograms/formoterol 12micrograms)

^Refer to manufacturer’s dosing

instructions or BNF for further advice.

NB. Different strengths of inhalers may be slightly different colours to those illustrated.

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Compound Preparations (Corticosteroid/ Long-acting beta2 agonist)
BECLOMETASONE/FORMOTEROL

Fostair Maintenance Therapy Fostair Reliever Therapy

Fostair 100/6
Fostair 100/6 √
√ √ 1 puff Inhal SOB/wheeze
1 puff Inhal 01/02/13

6x 01/02/13
A N Other (A N OTHER) A N Other (A N OTHER) day

MDI
√

Example of medicine prescription form Example of medicine prescription form

Fostair®
(aerosol)
Strength: 100/6 (belcometasone 100 micrograms/
formoterol 6 micrograms)^

^Refer to manufacturer’s dosing

instructions or BNF for further advice.

NB. Different strengths of inhalers may be slightly different colours to those illustrated.

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Compound Preparations (Corticosteroid/ Long-acting beta2 agonist)
FLUTICASONE/FORMOTEROL

Flutiform 125/5
√ √
2 puffs Inhal 01/02/13

A N Other (A N OTHER)

MDI
√

Example of medicine prescription form

Flutiform®
(aerosol)
Strengths^: 50/5 (fluticasone 50 micrograms/formoterol 5 micrograms)
125/5 (fluticasone 125 micrograms/formoterol 5 micrograms)
250/10 (fluticasone 250 micrograms/formoterol 10 micrograms)

^Refer to manufacturer’s dosing

instructions or BNF for further advice.

NB. Different strengths of inhalers may be slightly different colours to those illustrated.

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Spacer Devices
Some patients use spacer devices which remove the need for coordination between actuation of a
pressurised metered-dose inhaler (MDI) and inhalation. Spacers reduce the velocity of the aerosol and
subsequent impaction on the oropharynx and allow more time for evaporation of the propellant so that a
larger proportion of the particles can be inhaled and deposited in the lungs.

Spacers should be cleaned once a month and replaced every 6 to 12 months. It is important to prescribe a
spacer device that is compatible with the MDI. Spacer devices should not be regarded as interchangeable;
patients should be advised not to switch between spacer devices.

Volumatic®

• Large-volume device

• Compatible with all GlaxoSmithKline

brand MDIs eg. Ventolin®, Serevent®,
Flixotide®, Seretide® and also Clenil Modulite®

• Also available with paediatric facemask

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Spacer Devices
AeroChamber® Plus Able Spacer® A2A Spacer®

• Medium-volume device • Small-volume device • For use with all pressurised 0

• For use with all pressurised (aerosol) inhalers* • For use with all pressurised (aerosol) inhalers*
• Available as standard device (blue), child (aerosol) inhalers* • Available with small or
device (yellow), infant device (orange) • Available with infant (small), medium mask
• Also available with facemask child (medium) or adult (large) mask

Optichamber® Vortex Spacer® Pocket Chamber®

• For use with all pressurised 0 • Medium-volume device • Small-volume device

(aerosol) inhalers* • For use with all pressurised • For use with all pressurised
• Available with small, medium (aerosol) inhalers* (aerosol) inhalers*
or large mask • Available with infant, child or adult mask • Available with infant, small,
medium or large mask
*Please check compatibility of all inhaler devices before prescribing.
Flutiform® has not been tested with all of the spacers listed on this page.

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