Clarification on what constitutes a High Risk Asthmatic.
We have been asked to provide any clarification on what is classed as an Asthmatic, which you appreciate is a very widespread term.
The Asthma UK organisation has clarified with the Department of Health on who is in the high risk category of Asthmatic Vulnerable persons.
The Department of Health will be contacting individuals who they have assessed (from GP or Specialist notes) as being within the Vulnerable person groups, therefore your affected staff may provide that contact information with you for clarity. If a person is in these groups, they will get a text message or a letter this week. If an individual haven't heard anything by the 29th March, and they think they are in a high risk group, they should contact their GP.
The classification of a high risk Asthmatic is:
If you are, or your child is, taking:
- Any biologic therapy, also called a mAb (Xolair/omalizumab, Nucala/mepolizumab, Cinqaero/reslizumab, Fasenra/benralizumab)
- Steroid tablets or liquid every day
- Antibiotic tablets or liquid for asthma every week (e.g. azithromycin)
- Tiotropium
- A combination inhaler that also contains a long-acting bronchodilator (e.g. Seretide, Fostair, Symbicort) at a high daily steroid dose (see the list below)
- An inhaler with a high daily steroid dose (see the list below) AND you are taking Montelukast
Then you should follow the shielding advice, which means:
- Stay at home at all times and avoid any face-to-face contact with others for at least 12 weeks.
Classification of slightly lower risk Asthmatics:
If you are not on the medicines listed above, but any of these apply to you:
- You have had an admission to hospital in the last year,
- You have needed 2 or more courses of oral steroids in the last year, OR
- You are using your blue reliever inhaler 3 or more times per week
Then you may benefit from stricter social distancing. If you are using your reliever inhaler more than 3 times a week, current advice is that you speak to your GP or asthma nurse about improving your asthma control as soon as possible.
There is a comprehensive list of steroids below.
Relevant link: https://www.asthma.org.uk/coronavirus
Any questions or queries please get in touch.
Kind regards
Nick
What is a high daily steroid dose for different inhalers?
If you are on the dose listed or more, then it is considered a high daily dose of steroids. This will help you work out if you need to follow the shielding advice above.
We have taken this list from the British Thoracic Society’s guideline on asthma management and information from our clinical advisers. If your inhaler is not listed, it may not be able to be prescribed at a high dose. If you think you might be on a high dose and your inhaler is not listed here, you can contact your asthma nurse or pharmacist for advice.
|
Inhaler |
Adult |
Child |
|
Clenil Modulite pMDI |
250 micrograms 2 puffs twice a day |
200 micrograms 2 puffs twice a day |
|
Kelhale pMDI |
100 micrograms 4 puffs twice a day |
|
|
Qvar pMDI, Autohaler or Easi-Breathe |
100 micrograms 4 puffs twice a day |
100 micrograms 2 puffs twice a day |
|
Soprobec pMDI |
250 micrograms 2 puffs twice a day |
200 micrograms 2 puffs twice a day |
|
Alvesco pMDI |
160 micrograms 2 puffs twice a day |
160 micrograms 2 puffs once a day |
|
Flixotide Evohaler |
250 micrograms 2 puffs twice a day |
125 micrograms 2 puffs twice a day |
|
Budesonide Easyhaler |
400 micrograms 2 puffs twice a day |
200 micrograms 2 puffs twice a day |
|
Budelin Novolizer |
200 micrograms 4 puffs twice a day |
200 micrograms 2 puffs twice a day |
|
Pulmicort Turbohaler |
400 micrograms 2 puffs twice a day |
200 micrograms 2 puffs twice a day OR 400 micrograms 1 puff twice a day |
|
Flixotide Accuhaler |
500 micrograms 1 puff twice a day |
250 micrograms 1 puff twice a day |
|
Fostair pMDI or NEXThaler |
200/6 two puffs twice a day |
|
|
DuoResp Spiromax |
320/9 two puffs twice a day |
320/9 one puff twice a day OR 160/4.5 two puffs twice a day |
|
Symbicort Turbohaler |
400/12 two puffs twice a day |
200/6 two puffs twice a day |
|
Fobumix Easyhaler |
320/9 two puffs twice a day |
|
|
Flutiform MDI |
250/10 two puffs twice a day |
125/5 two puffs twice a day |
|
Flutiform K-Haler |
Not licensed at high doses |
125/5 two puffs twice a day |
|
Aerivio Spiromax |
500/50 one puff twice a day |
|
|
AirFluSal Forspiro |
500/50 one puff twice a day |
|
|
AirFluSal pMDI |
250/25 two puffs twice a day |
|
|
Aloflute pMDI |
250/25 two puffs twice a day |
|
|
Combisal pMDI |
250/25 two puffs twice a day |
125/25 two puffs twice a day |
|
Fusacomb Easyhaler |
500/50 one puff twice a day |
|
|
Sereflo pMDI |
250/25 two puffs twice a day |
|
|
Seretide Accuhaler |
500/50 one puff twice a day |
250/50 one puff twice a day |
|
Seretide Evohaler |
250/25 two puffs twice a day |
125/25 two puffs twice a day |
|
Sirdupla pMDI |
250/25 two puffs twice a day |
|
|
Stalpex Orbicel |
500/50 one puff twice a day |
|
|
Relvar Ellipta |
184/22 one puff once a day |
92/22 one puff once a day |
|
Asmanex Twisthaler |
400 micrograms 1 puff twice a day |
200 micrograms 1 puff twice a day |
|
If being used as part of a MART regime |
|
|
Fostair pMDI or NEXThaler |
100/6 one puff twice a day + 1 additional puff when necessary (if using at least 5 puffs each day on average) |
|
Symbicort Turbohaler |
100/6 two puffs each day + 1 additional puff when necessary (if using at least 10 puffs each day on average) |
|
Symbicort Turbohaler |
200/6 two puffs each day + 1 additional puff when necessary (if using at least 5 puffs each day on average) |
|
DuoResp Spiromax |
160/4.5 two puffs each day + 1 additional puff when necessary (if using at least 5 puffs each day on average) |
|
Fobumix Easyhaler |
80/4.5 two puffs each day + 1 additional puff when necessary (if using at least 10 puffs each day on average) |
|
Fobumix Easyhaler |
160/4.5 two puffs each day + 1 additional puff when necessary (if using at least 5 puffs each day on average) |