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BNSSG Paediatric Joint Formulary

3.1 Airways disease, obstructive

Last edited: 31-01-2024

3.1 Airways disease, obstructive

First line drugs Second line drugs Specialist drugs Secondary care drugs



  • NICE TA10 Guidance on the use of inhaler systems (devices) in children under the age of 5 years with chronic asthma.
  • NICE TA38 Inhaler devices for routine treatment of chronic asthma in older children (aged 5–15 years)




Short-acting Beta2 Agonists


Salbutamol (inhaled & nebulised) (TLS Green)


Terbutaline (inhaled & nebulised) (TLS Blue)

Specific indication:

Salbutamol (parenteral) (TLS Blue)


Antimuscarinic Bronchodilators

Ipratropium nebules


Longer-acting Beta2 Agonists

Patients with asthma on long-acting reliever inhalers (long-acting beta agonists (LABA) and/or long-acting muscarinic receptor antagonists (LAMA) with no inhaled corticosteroid (ICS) are at greater risk of severe asthma attacks.

Salmeterol (TLS Green)

Formoterol (TLS Green)



Refer to Global Initiative for Asthma (GINA) Reference guide

Refer to the BNSSG Paediatric guidelines

Standard inhaler (pMDI) and spacer (TLS Green)

  • Choice of inhaler device should be based on patient preference and assessment of use


Other inhaler (TLS Blue)


Inhaled Corticosteroids


Beclometasone (inhaled) (TLS Green)

  • Includes Clenil Modulite® and Qvar®
  • Please prescribe by brand name as they are not bioequivalent
  • Qvar® not licensed for patients under 12


Fluticasone (inhaled & nebulised) (TLS Blue)

Fluticasone (TLS Red)

  • For eosinophilic oesophagitis

Combination products: (TLS Green)

Relvar Ellipta® (Fluticasone furoate / Vilanterol)

  • Asthma - consider 184/22 micrograms and 92/22 micrograms inhaler at Step 4 of BNSSG Asthma guidance for Children aged 12-18 years

Fluticasone propionate / Salmeterol

  • According to licenses in Paediatrics

Flutiform®(Fluticasone propionate / Formoterol)

Fostair® (Beclometasone / Formoterol)

Fostair® NEXThaler (Beclometasone / Formoterol)

Symbicort® (Budesonide / Formoterol)

  • Includes 100/3 pMDI
  • Caution note: Prescribers should be aware that new inhaler devices entering the market are moving away from the traditional blue for reliever and brown for preventer colours. It is important that any changes made to a patient's inhaler treatment considers the patient's understanding of the use of that inhaler and are aware of these changes before a new inhaler is prescribed. Caution should be exercised in patients where understanding is not assured
  • Patients should be started at a dose of inhaled steroids appropriate to the severity of disease. The dose should be titrated to the lowest dose at which effective control of the disease is maintained
  • NICE TA138 Asthma - inhaled corticosteroids for the treatment of chronic asthma in adults and children aged 12 years and over
  • NICE TA131 Inhaled corticosteroids for the treatment of chronic asthma in children under the age of 12 years


Systemic Corticosteroids

Systemic steroids should only be used for patients with asthma whose disease cannot be controlled with appropriate doses of inhaled therapies according to BTS/SIGN Guidelines.


Prednisolone (oral) (TLS Green)

Hydrocortisone (parenteral) (TLS Red)


Leukotriene Receptor Antagonists

Montelukast (TLS Green)


Monoclonal Antibodies

Specific Indication:

Omalizumab (TLS Red)

  • Commissioned by NHS England Specialised Services Commissioning
  • NICE TA278 Omalizumab for treating severe persistent allergic asthma (review of technology appraisal guidance 133 and 201)



Prescribe by brand

Theophylline modified-release (TLS Amber Specialist Recommended)


Aminophylline (intravenous) (TLS Red)


Peak Flow Meters, Inhaler Devices and Nebulisers


Peak Flow Meters

Peak Flow Meter (standard range) (TLS Green)



Only to be initiated by a specialist for patients who need acute treatment or are unable to use inhaled devices effectively.

University Hospitals Bristol Patient information for nebulisers

Salbutamol nebules (TLS Green)

Ipratropium nebules (TLS Green)

  • Ipratropium nebs should not be weaned, as patients then get a sub-therapeutic dose

Budesonide nebules (TLS Green)

  • For respiratory indications

Sodium chloride 0.9% (TLS Green)

  • Used as diluent