Audits - Respiratory

Please select from the following Audits.

Bronchodilator review

This review is part of the 2015-16 Prescribing LES

The National Review of Asthma Deaths (May 2014) highlighted four key messages which would have significant impact on asthma mortality, one of which was better monitoring of asthma control; where loss of control is identified, immediate action is required including escalation of responsibility, treatment change and arrangements for follow-up.

Using >10-12 puffs per day of a bronchodilator is a marker of poorly controlled asthma that puts patients at risk of fatal or near-fatal asthma (SIGN guidelines, Oct 2014 ) The use of 18 cannisters per 12 month period is equivalent to 10 puffs daily. If a patient are using more than 3 doses of bronchodilator weekly, inhaled corticosteroids should be prescribed at an appropriate level to achieve control. (SIGN guidelines, Oct 2014)

This project aims to identify those patients who appear to be over ordering their bronchodilator inhalers and highlight them for review of their overall asthma management.

Bronchodilator reviewDownload File
(Bronchodilato Overuse Review[.pdf)

Date Uploaded: 20/05/2015

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COPD Combination Inhaler Review

Respiratory prescribing is long term and can be costly. Appropriate choice and use of inhaled therapy is key to successful management of COPD. D&G formulary recommends either Duoresp® Spiromax® (a dry powder inhaler DPI) or Fostair® MDI as first line choice in patients, over 18 years of age, with COPD. Duoresp Spiromax® has been shown to have comparable quality and be bioequivalent to the same strengths of Symbicort® turbohaler. It is also expected to have the same benefits as Symbicort® in improving lung function and relieving symptoms in COPD

COPD Combination Inhaler ReviewDownload File
(COPD Combination Inhaler Review.pdf)

Date Uploaded: 20/05/2015

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Asthma Combination Inhaler Review

Appropriate choice and use of inhaled therapy is essential for the successful management of asthma. Combination inhalers are recommended to ensure that long-acting β2 agonists are not taken without inhaled steroids and also to improve inhaler adherence

Respiratory prescribing is long term and can be costly. This audit aims to review the use of combination inhalers in patients with asthma to ensure that treatment is appropriate, cost effective and following local formulary guidance where able.

Asthma Combination Inhaler ReviewDownload File
(Asthma combination inhalers review.pdf)

Date Uploaded: 20/05/2015

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Asthma in children review

This audit will highlight patients under 18 years of age with a diagnosis of asthma and aims to ensure appropriate treatment and follow up is in place. All patients with a diagnosis of asthma under 18 years of age prescribed an inhaled corticosteroid inhaler with an equivalent beclomethasone daily dose greater than 400micrograms.

Asthma in children reviewDownload File
(Asthma in children review.pdf)

Date Uploaded: 20/05/2015

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Asthma Prescribing Review

Appropriate choice and use of inhaled therapy is key to successful management of asthma. Further to this respiratory prescribing is long term and can be costly. It is therefore recommended that patients with asthma are reviewed regularly with a view to maintaining control of their symptoms on the lowest step of the asthma step management plan. This project aims to assess the level at which the patient is being controlled according to BTS/SIGN guidelines (Oct 2014) and review their treatment to ensure that it is on the lowest controlling step. The Asthma Control Test (ACT) can be used as an aid to assess control in this project.

Asthma Prescribing  Review Download File
(Asthma Prescribing Review.pdf)

Date Uploaded: 20/05/2015

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COPD Prescribing review

Respiratory prescribing is long term and can be costly. Appropriate choice and use of inhaled therapy is key to the successful management of COPD. In COPD, there is a need to review use of inhaled steroids as their use when FEV1 is above 50% is not recommended and can lead to increased risk of pneumonia and other respiratory infections.1 This audit will highlight patients currently prescribed an inhaled corticosteroid for the treatment of COPD and will make recommendations where appropriate in order to stop or change to the most cost effective, formulary option. D&G formulary recommends either Duoresp Spiromax® (a dry powder inhaler DPI) or Fostair® MDI as first line choice in patients, over 18 years of age, with COPD. Duoresp Spiromax® has been shown to have comparable quality and be bioequivalent to the same strengths of Symbicort® turbohaler. It is also expected to have the same benefits as Symbicort® in improving lung function and relieving symptoms in COPD.

COPD Prescribing reviewDownload File
(COPD Prescribing Review.pdf)

Date Uploaded: 09/08/2012

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Easyhaler Review Audit

Easyhaler® inhalers (salbutamol, formoterol, budesonide, beclometasone) are the dry powder of choice within the limitations of their available strengths. The cost savings comparing like for like (dose and number of actuations) range from £1.97 to £17.39 for 60 doses i.e. one month assuming a 1 puff twice daily dosage.

Easyhaler Review AuditDownload File
(Easyhaler Review Protocol.pdf)

Date Uploaded: 03/08/2011

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Salmeterol to Combination inhalers

The stepwise approach to the treatment of asthma in adults as outlined in the ‘SIGN 101 Guideline for the Management of Asthma’ recommends the use of an inhaled beta agonist (step 1) followed by the addition of an inhaled corticosteroid (ICS, step 2) and a long acting beta agonist (LABA, step 3). The addition of a LABA i.e. salmeterol/formoterol suggests that these patients will have already been prescribed an ICS as per the SIGN guidelines. CHM advice is that LABAs should only be added only if regular ICS have failed to control asthma adequately and should only be used in asthma where patients are regularly using an ICS.

Salmeterol to Combination inhalersDownload File
(Salmeterol to combined inhaler switch.pdf)

Date Uploaded: 10/11/2010

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Seretide Audit

This audit will highlight patients currently prescribed the Seretide Evohaler for whom the Accuhaler may be appropriate.

Seretide inhalers are available as meter dose inhalers (Seretide Evohaler) and breath-actuated dry powder inhalers (Seretide Accuhaler). Only the Seretide 500 Accuhaler (Salmeterol 50mcg/Fluticasone 500mcg) is licensed for the symptomatic treatment of patients with COPD. All preparations are licensed for use in patients with asthma. Seretide 500 Accuhaler 1 puff twice daily is significantly more cost-effective than the equivalent Evohaler 250 2 puff twice daily.

Seretide AuditDownload File
(SeretideAuditProtocol.pdf)

Date Uploaded: 31/12/2007

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