New COPD prescribing guidelines
The GYWCCG guidelines for COPD treatment have now been updated in conjunction with the respiratory team at JPUH. They are based on the GOLD 2017 guidelines. The previous version followed NICE 2010 guidance.
GOLD prescribing decisions are based on the patient’s current symptoms and exacerbations whilst NICE follows a step up approach. The new guidance for GY&W ONLY contains a meter dose inhaler (MDI) and dry powdered inhaler (DPI) option for each group. Inhaler technique should be assessed whenever treatment is reviewed.
Included in the new quick reference guidance are single devices to deliver triple therapy. GY&W CCG will be supporting practices to switch appropriate patients to a triple combination therapy inhaler. There are currently two available;
- Trimbow MDI (87 micrograms of beclometasone dipropionate, 5 micrograms of formoterol fumarate dihydrate and 9 micrograms of glycopyrronium (as 11 micrograms glycopyrronium bromide))
- Appropriate switch from LABA plus ICS/LABA MDI
- Trelegy Ellipta (DPI) (92 micrograms fluticasone furoate, 65 micrograms umeclidinium bromide equivalent to 55 micrograms umeclidinium and 22 micrograms vilanterol (as trifenatate)).
- Appropriate switch from LABA plus ICS/LABA DPI
This switch is beneficial to patients who are unsuitable for ICS step down and who therefore need to remain on triple therapy. By prescribing one triple therapy inhaler, patients will receive all their COPD inhaled medication in one device which may improve compliance. Prescribing a triple therapy inhaler is also cost effective with a minimum saving of £10.62 per device dispensed.
GY&W practices are currently identifying patients suitable to be switched to a triple therapy combination inhaler. Please could pharmacies support this transition using the New Medicines Service.
GY&W CCG will be starting a piece of work in the new year focusing on patients who are inappropriately prescribed ICS for COPD. More details will follow.
Self Care Referrals to Pharmacy from General Practice
Self-care guidance has been issued to all Norfolk GP practices this week to advise which conditions can be appropriately referred to community pharmacies as well as what may be bought and what may be prescribed for specific conditions:
This has been operating in Waveney since the summer but has now been agreed across all 5 Norfolk CCG’s. If you haven’t already done so, we recommend that pharmacy teams contact their local GP practices, or arrange with other local pharmacies to have a joint meeting with practice managers, to discuss the use of this guidance and potential issues. We suggest that as a minimum it would be useful to agree fast referral back to GP if any “red flag” symptoms are identified, which products may not be used out of licensing and ensuring consistent patient messages on what may and may not be prescribed.
GP’s in Great Yarmouth and Waveney CCG are being asked to issue leaflets to patients, when appropriate, instead of issuing antibiotics.
Inhaler product switch within Great Yarmouth & Waveney
There is a new inhaler on the market called Sirdupla which is equivalent to Seritide inhaler . Sirdupla is available in two strengths at present ( see below for strengths and pip codes, they are currently available from Alliance , Phoniex wholesalers, you would need to check AAH if this is your main wholesaler).
Clinicians may be switching patients from Seretide to Sirdupla in the near future.
|SIRDUPLA MDI 25MCG/125MCG
Pack of 120DS (1)
|SIRDUPLA MDI 25MCG/250MCG
Pack of 120DS (1)