Dear Patients,
It is apparent from the increase in enquires regarding if you are asthmatic and what group of risk are you in, that we should clarify from the current information we have. Please remember, that in the first instance the NHS will have contacted you by letter if you need to shield yourself for 12 weeks. We are currently awaiting their information to us, so that we may check all the patients that we have against that list. They are expected to return the information to us this week.
Asthma UK are a very useful group to gain information and have been very specific on the medication that puts someone in the ’12 week shielding’ group rather than the ‘at risk group’. Their website can be found here https://www.asthma.org.uk/advice/triggers/coronavirus-covid-19/
Shielding advice for very high-risk groups
The Government has released guidelines for people who would be at very high risk if they caught coronavirus because they have a severe respiratory condition, including severe asthma.
We are aware there has been some confusion about who should be shielding. We have been urgently clarifying this with Government and the NHS. We appreciate your patience, as identifying who is at high risk is a very challenging job that is having to be done at a fast pace.
If you or your child is in one of these groups, you should have already been identified and sent a letter or text message advising you to shield:
- You are taking ALL THREE OF:
- a steroid preventer inhaler (at any dose)
- another preventer medicine (e.g. you are on a combination inhaler, or take a medicine such as formoterol or salmeterol, or tiotropium as well as your steroid inhaler, or if you are taking montelukast)
-
regular or continuous oral steroids (which means you had 4 or more prescriptions for prednisolone between July and December 2019)
- Or you have been admitted to hospital in the last 12 months for your asthma
- Or you have ever been admitted to an intensive care unit for your asthma.
If you have not received a letter or text message yet, and you are in one of these groups, you should follow the shielding guidance anyway.
If you or your child is taking any of the below medicines:
You may not have received a letter advising you to shield yet, but we would advise you shield anyway.
This advice has been agreed in collaboration with the National Clinical Director for Respiratory at NHS England.
- Any biologic therapy, also called a mAb (Xolair/omalizumab, Nucala/mepolizumab, Cinqaero/reslizumab, Fasenra/benralizumab)
- Antibiotic tablets or liquid for asthma every week as a preventer (e.g. azithromycin)
- A combination inhaler that also contains a long-acting bronchodilator (e.g. Seretide, Fostair, Symbicort) at a high daily steroid dose (see the table below)
- An inhaler with a high daily steroid dose (see the table below) AND you are taking Montelukast
We know it might be challenging to go into shielding without having a letter to prove this to your employers. You can mutual aid network.
What is a high dose of inhaled steroids?
Look for the medicine in your inhaler in the list below. 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.
This list comes from the National Institute of Health and Care Excellence’s guideline on asthma, which you can find in full here.
If you have questions or concerns about the inhaler(s) or the dose that you are taking, contact your asthma healthcare team. They are the only people who can prescribe medicines for you or change the dose that you are taking.
Remember it is not the inhaler dose alone that means you need to go into shielding. Check the list above for criteria.
Inhaled steroid dosages for adults aged 17 years and over
| High dose | |
|---|---|
| Beclometasone dipropionate1 | |
| Standard particle CFC-free inhalers | 1,200–2,000 micrograms per day in 2 divided doses |
| Extra-fine particle CFC-free inhalers2 | 500–800 micrograms per day in 2 divided doses |
| Budesonide | |
| Dry powder inhalers | 1,000–1,600 micrograms per day in 2 divided doses |
| Ciclesonide | |
| Metered dose inhaler | 400–640 micrograms per day in 2 divided doses |
| Fluticasone propionate | |
| Metered dose and dry powder inhalers3 | 600–1,000 micrograms per day in 2 divided doses |
| Fluticasone furoate4 | |
| Dry powder inhaler | 200 micrograms as a single daily dose |
| Mometasone furoate | |
| Dry powder inhaler | Up to 800 micrograms per day in 2 divided doses |
| 1 CFC-containing beclometasone dipropionate MDIs are no longer available, so are not included. The MHRA advises that beclometasone dipropionate CFC-free inhalers should be prescribed by brand name (Drug safety update, July 2008).2 Extra-fine particle CFC-free inhalers include brands such as Qvar and Fostair, which are more potent than standard particle CFC-free inhalers. Fostair and Fostair NEXThaler are combination products containing beclometasone dipropionate with formoterol. The manufacturer’s SPC and the BNF indicate that 100 micrograms of beclometasone dipropionate via Qvar products are approximately equivalent to 200–250 micrograms of beclometasone dipropionate in standard particle CFC-free inhalers, and 200–250 micrograms of budesonide; 100 micrograms of beclometasone dipropionate via Fostair products are equivalent to 250 micrograms of beclometasone dipropionate in standard particle CFC-free inhalers.3 Flixotide Evohaler and Flixotide Accuhaler are licensed up to 2,000 micrograms per day (in 2 divided doses), which is approximately equivalent to 4,000 micrograms per day of budesonide. The manufacturer’s SPC advises that, because of the risk of systemic effects, doses of fluticasone propionate above 1,000 micrograms per day should be prescribed only for adults aged 17 years and over with severe asthma where additional clinical benefit is expected, demonstrated by either an improvement in pulmonary function and/or symptom control, or by a reduction in oral corticosteroid therapy.
4 At the time of publication (July 2018), fluticasone furoate was available only in a combination product, Relvar Ellipta (fluticasone furoate with vilanterol). The manufacturer’s SPC states that in people with asthma, fluticasone furoate 100 micrograms once daily is approximately equivalent to fluticasone propionate 250 micrograms twice daily, and fluticasone furoate 200 micrograms once daily is approximately equivalent to fluticasone propionate 500 micrograms twice daily. See also the NICE evidence summary Asthma: fluticasone furoate/vilanterol (Relvar Ellipta) combination inhaler (2014). |
|
Inhaled steroid dosages for children aged 5 to 11 years
| Paediatric high dose | |
|---|---|
| Beclometasone dipropionate1 | |
| Standard particle CFC-free inhalers | 500–800 micrograms per day |
| Extra-fine particle CFC-free inhalers2 | 300–400 micrograms per day in 2 divided doses |
| Budesonide | |
| Dry powder inhalers | 500–800 micrograms per day in 2 divided doses |
| Ciclesonide | |
| Metered dose inhaler3 | 240–320 micrograms per day in 2 divided doses |
| Fluticasone propionate | |
| Metered dose and dry powder inhalers4 | 250–400 micrograms per day in 2 divided doses |
| 1 CFC-containing beclometasone dipropionate MDIs are no longer available, so are not included. The MHRA advises that beclometasone dipropionate CFC-free inhalers should be prescribed by brand name (Drug safety update, July 2008).2 Extra-fine particle CFC-free inhalers include brands such as Qvar, which are more potent than standard particle CFC-free inhalers. The manufacturer’s SPC and the BNF indicate that 100 micrograms of beclometasone dipropionate via Qvar products are approximately equivalent to 200–250 micrograms of beclometasone dipropionate in standard particle CFC-free inhalers, and 200–250 micrograms of budesonide. At the time of publication (July 2018), Qvar products did not have UK marketing authorisations for use in children aged under 12 years (see notes on page 1). Dosages in this table are based on Global Initiative for Asthma (GINA) 2018 recommendations for children aged 6 to 11 years.3 At the time of publication (July 2018), ciclesonide (Alvesco) did not have UK marketing authorisation for use in children aged under 12 years (see notes on page 1). Dosages in this table are based on Global Initiative for Asthma (GINA) 2018 recommendations for children aged 6 to 11 years.
4 At the time of publication (July 2018), the only licensed dosage of fluticasone propionate for children aged 4 to 11 years via the combination products Seretide Accuhaler and Seretide Evohaler (fluticasone propionate with salmeterol) was 200 micrograms per day in 2 divided doses. |
|
Information correct as of 1/4/2020 16:23