Recommendations for travelling with bronchiectasis: a joint ELF/EMBARC/ERN-Lung collaboration

Michal Shteinberg; Barbara Crossley; Tal Lavie; Sima Nadler; Jeanette Boyd; Felix C. Ringshausen; Tim Aksamit; James D. Chalmers; Pieter Goeminne

doi:10.1183/23120541.00113-2019

Tables

TABLE 1

Statements included in the questionnaire for experts and percentage agreement

Statement	Agree	Disagree
Is it safe for all people with bronchiectasis to travel?
Most people with bronchiectasis can safely travel for vacation or business	96%	4%
It is best to avoid travelling during periods of unstable disease, such as during exacerbations	92%	8%
People with bronchiectasis should consult their healthcare providers and plan for travel	85%	15%
People with very severe bronchiectasis (e.g. candidate for lung transplantation, frequent hospitalisation) should be advised not to travel abroad	73%	27%
Planning travel: are there destinations and conditions that certain people with bronchiectasis should avoid?
People with bronchiectasis should try to avoid travelling to places with high levels of air pollution	73%	27%
People with bronchiectasis should try to avoid travelling to places with a high prevalence of NTM (e.g. Hawaii, USA)	38%	62%
People with bronchiectasis should try to avoid travelling during influenza season	35%	65%
People with bronchiectasis should consult their healthcare professional regarding staying at high altitudes	85%	15%
Travelling to high-altitude destinations (above 3050 m/10 000 ft) should be avoided in people with bronchiectasis^#	32%	68%
People with bronchiectasis should preferably travel to destinations with a nearby bronchiectasis centre	31%	69%
What travel insurance should people with bronchiectasis acquire?
Health insurance with coverage of deterioration of a chronic condition	100%
Health insurance with coverage of hospital admission and emergency room visits^#	100%
Health insurance with coverage of repatriation^#	68%	32%
What medications and devices should people with bronchiectasis carry with them when travelling?
When travelling, it is recommended that people with bronchiectasis should continue taking their regular treatments and make arrangements to take enough medications and equipment for the duration of their travel	100%
When travelling, people with bronchiectasis should consult their healthcare professional or respiratory physiotherapist regarding possible alternatives to heavy or large equipment (e.g. nebulisers)	100%
People with bronchiectasis who suffer frequent pulmonary exacerbations should consult their specialist regarding carrying antibiotics to be used in case of a pulmonary exacerbation when travelling	100%
Medications taken for travel should be properly stored according to manufacturer's recommendations (particularly storage temperature, light exposure)	100%
Electricity requirements (e.g. for a nebuliser) and cleaning instructions should be known prior to travelling and proper adaptations, including checking batteries, should be planned	100%
How can people with bronchiectasis maintain regular treatments when in transport?
It is advised that airway clearance and inhalations are performed while waiting at airports before and after flights. This is best planned ahead and checked with the airport for the best place to do this	77%	23%
While it is not advised to take cough suppressants for bronchiectasis, it may be considered for long flights where a cough may be disturbing to other passengers	35%	65%
Do people with bronchiectasis need to prepare and carry certain documents?
It is advised that patients with bronchiectasis carry documentation from the last clinic/hospitalisation visit, translated into English and preferably also into the language of the country of destination	81%	19%
A document for travel may be prepared and should include: patient's health status, allergies, chronic bacterial infections, regular medications and devices used regularly, recommended medications during exacerbation	100%
It is advised that patients with bronchiectasis carry a translation of a disability card^# (such as a European Union disability parking card) if eligible and where available	84%	16%
When travelling in a guided tour, it is advised that people with bronchiectasis should notify the travel company of their condition	69%	31%
What are oxygen requirements on the flight and at the travel destination?
Oxygen requirements during commercial flights should be predicted before flight	100%
In people with an FEV₁ <55% pred or oxygen saturation <93% at ambient air, a hypoxia inhalation test should be performed	77%	23%
In people with FEV₁ <1.5 L, a hypoxia inhalation test should be performed^#	44%	56%
When planning travel to destinations between 2000 and 3050 m, considerations as for commercial flights should be made	92%	8%
How else can people with bronchiectasis be prepared to travel?
It is recommended that people with bronchiectasis seek advice for travellers and follow recommended immunisations for the destination	100%
Recommended medications while travelling (such as for the prevention of malaria) should be checked for interactions with regular treatments and with treatments during exacerbations	100%
It is recommended that people with bronchiectasis should be stable prior to travelling, if symptoms typical for an exacerbation develop shortly before travelling, treatment should be started and travel postponed if possible	96%	4%
People with severe bronchiectasis and chronic Pseudomonas sp. infection may be advised to receive treatment with an intravenous antibiotic course shortly before travelling to prevent an exacerbation while away	50%	50%
What kind of activities may people with bronchiectasis engage in while on holiday and what precautions are recommended?
It is recommended that people with bronchiectasis should use sun protection while using medications that increase photosensitivity (e.g. ciprofloxacin, doxycycline)	100%
It is recommended that people with bronchiectasis take measures to avoid dehydration while in a hot climate	100%
It is advised that people with bronchiectasis maintain general measures of hygiene to prevent cross-infection: hand hygiene, wearing face masks in crowded places	88%	12%
It is recommended that all people with bronchiectasis refrain from SCUBA diving	35%	65%
It may be safe for people with bronchiectasis to SCUBA dive if they are asymptomatic (no sputum or shortness of breath at the time of diving) and lung function is normal (FEV₁ and peak expiratory flow should both be >80% pred, FEV₁/forced vital capacity >75%)	85%	15%
It is recommended that people with bronchiectasis should be aware of their own limitations to strenuous activities and limit their participation in such activities accordingly. This refers to sports including hiking, swimming and snorkelling, but also less strenuous activities such as short walks uphill and climbing stairs	96%	4%
Where should people with bronchiectasis get help if they get sick while away?
Prior to travel, people with bronchiectasis should be advised on increasing airway clearance if suffering an exacerbation while away	96%	4%
Prior to travel, people with bronchiectasis should be advised when to take antibiotics, including a recommendation for an oral antibiotic, dose and duration	100%
People with bronchiectasis should be advised when and where to seek medical care at their destination	88%	12%

NTM: nontuberculous mycobacteria; FEV₁: forced expiratory volume in 1 s; SCUBA: self-contained underwater breathing apparatus; % pred: % predicted. ^#: 25 out of 26 responded; all other items had 26 responses.

TABLE 2

Examples of equations for predicting hypoxaemia

P_aO₂ _Alt=0.410×P_aO₂_Ground+17.652

P_aO₂ _Alt=0.519×P_aO₂_Ground+11.855×(FEV₁ L)−1.760

P_aO₂ _Alt=0.453×P_aO₂_Ground+0.386×(FEV₁ % pred)+2.44

P_aO₂ _Alt=22.8−(2.74×altitude in 1000s of feet)+0.68×P_aO₂_Ground

P_aO₂ _Alt: predicted arterial oxygen tension at altitude (in millimetres of mercury); P_aO₂_Ground: measured arterial oxygen tension at sea level (in millimetres of mercury); FEV₁: forced expiratory volume in 1 s; % pred: % predicted. Information from [10].

TABLE 3

Storage conditions for common medications for bronchiectasis

Drug name	Common trade names in Europe	Storage conditions	Comments
Oral antibiotics and antifungals
Azithromycin	Cap. azithromycin 250 mg Cap. Azenil 250 mg Cap. azithromycin Inovamed 250 mg Cap. Zithromax 250 mg Tab. Zeto 250 mg Tab. azithromycin 250 mg	Cap., tab.: store in the original package in order to protect from light; store below 25°C	Skin photosensitivity: uncommon (≤1%) Alcohol: no special recommendation
Azithromycin	Azenil 200 mg/5 mL powder for oral susp. Azithromycin 200 mg/5 mL powder for oral susp. Azithromycin Teva 200 mg/5 mL powder for oral susp. Zithromax 200 mg/5 mL powder for oral susp.	Powder for susp.: store below 25°C Reconstituted susp.: store at room temperature, below 25°C After reconstitution of the powder, use the susp. within 5 days; shake immediately prior to use
Erythromycin	Tab. erythromycin 250 mg Tab. Erythro Teva 250 mg; 500 mg Tab. Erythrocin 250 mg; 500 mg Tab. Erythroped A 500 mg	Tab.: store in a dry place, below 25°C	Alcohol: may decrease the absorption of erythromycin or enhance effects of alcohol (ethanol); the combination should be avoided
Erythromycin	Erythromycin SF granules for oral susp. 125 mg/5 mL; 250 mg/5 mL; 500 mg/5 mL Erythromycin ethyl succinate granules for oral susp. 125 mg/5 mL; 250 mg/5 mL; 500 mg/5 mL Erythroped SF 250 mg/5 mL; 500 mg/5 mL Primacine granules for oral susp. 250 mg/5 mL	Granules for susp.: store below 25°C Reconstituted susp.: store in a refrigerator (2–8°C); do not freeze After reconstitution, use the suspension within 14 days; shake immediately prior to use
Roxithromycin	Tab. Rulid 150 mg; 300 mg Tab. Roxo 150 mg	Tab.: store below 25°C	Alcohol: no special recommendation
Clarithromycin	Tab. Karin 250 mg, 500 mg Tab. Klacid SR 500 mg Tab. clarithromycin 250 mg, 500 mg Tab. Klaricid XL 500 mg Prolonged release tab. Mycifor XL 500 mg Caplets Klaridex 250 mg	Tab., caplets: store in the original package in order to protect from light and moisture; store below 25°C (some manufacturers permit excursions up to 30°C)	Alcohol: no special recommendation
	Sachet Klaricid adult 250 mg	Sachet: store in a dry place, below 30°C Mix the contents of the sachet with a small amount of water before taking to make the granules easier to swallow
	Klacid paediatric granules for susp. 125 mg/5 mL Susp. Clarithromycin 125 mg/5 mL; 250 mg/5 mL Oral susp. clarithromycin 125 mg/5 mL; 250 mg/5 mL Klaricid paediatric susp. 125 mg/5 mL; 250 mg/5 mL	Granules for susp.: store below 30°C Reconstituted susp.: store at room temperature, below 25°C (up to 30°C according to manufacturer) and use within 14 days from reconstitution; do not refrigerate or freeze the reconstituted suspension; shake immediately prior to use
Amoxicillin	Cap. amoxicillin 250 mg; 500 mg Cap. Amoxil 250 mg; 500 mg Cap. Moxyvit 250 mg Cap. Moxyvit forte 500 mg Cap. Moxypen forte 500 mg	Cap.: store in a dry place, below 25°C	Alcohol: no special recommendation
Amoxicillin	Amoxicillin powder for oral susp. 125 mg/5 mL; 250 mg/5 mL Amoxicillin powder for oral susp. SF 125 mg/5 mL; 250 mg/5 mL Moxyvit forte powder for oral susp. 250 mg/5 mL Moxypen forte powder for susp. 250 mg/5 mL	Powder for susp.: store in a dry place, below 25°C Reconstituted susp.: according to manufacturer instructions, store in a refrigerator (2–8°C) or at room temperature (below 25°C) and use within 7–14 days^#; shake immediately prior to use	Alcohol: no special recommendation
Amoxicillin–clavulanic acid	Tab. Amoxiclav Teva 875 mg Tab. Augmentin 250 mg; 500 mg; 875 mg Tab. co-amoxiclav 250 mg; 500 mg Tab. Maclivan 500 mg	Tab.: store in the original package in order to protect from moisture; store below 25°C Augmentin tab. supplied in an aluminium pouch should be used within 30 days of opening the pouch	Alcohol: no special recommendation
Amoxicillin–clavulanic acid	Augmentin powder for oral susp. 250 mg/5 mL; 400 mg/5 mL Augmentin ES Augmentin powder for oral susp. 600 mg/5 mL Co-amoxiclav powder for oral suspension 125 mg/5 mL; 250 mg/5 mL; 400 mg/5 mL Maclivan powder for oral suspension 250 mg/5 mL; 400 mg/5 mL	Powder for susp.: store in the original package in order to protect from moisture; store below 25°C Reconstituted susp.: according to manufacturer instructions, store in a refrigerator (2–8°C) and use within 7–10 days^#	Alcohol: no special recommendation
Doxycycline	Cap. Doxy 100 mg Cap. doxycycline 50 mg; 100 mg Cap. Vibramycin Hyclate 100 mg Tab. Doxylin 100 mg Vibramycin-D 100 mg Dispersible tabs Vibra-Tabs 100 mg	Cap., tab.: store in the original package in order to protect from light and moisture; store below 25°C^#	Skin photosensitivity: sunlight or ultraviolet light exposure increases the risk of photosensitivity; use skin protection and avoid prolonged exposure to sunlight and ultraviolet light; avoid use of tanning equipment. Discontinue the treatment at first sign of skin erythema Alcohol: ingestion may shorten the half-life of doxycycline and reduce its serum concentration; the combination should be avoided
Doxycycline	Doxycycline powder for susp. 25 mg/5 mL Vibramycin monohydrate powder for susp. 25 mg·mL⁻¹	Powder for susp.: store in the original package in order to protect from light and moisture; store below 25°C^# Reconstituted susp.: store in the original package in order to protect from light and moisture; store below 25°C (up to 30°C according to manufacturer); use within 14 days from reconstitution; shake immediately prior to use
	Vibramycin calcium syrup 50 mg·mL⁻¹	Syrup: store in the original package in order to protect from light and moisture; store below 30°C
Minocycline	Cap. minocycline 50 mg; 100 mg Cap. Minoclin 100 mg Tab. minocycline 50 mg; 100 mg	Cap., tab.: store in the original package in order to protect from light; store below 25°C	Skin photosensitivity: may cause photosensitivity; use skin protection and avoid prolonged exposure to sunlight and ultraviolet light; avoid use of tanning equipment Discontinue the treatment if skin erythema occurs Alcohol: no special recommendation
Cefuroxime	Tab. Zinnat 125 mg; 250 mg; 500 mg Tab. Cefuroxime 250 mg	Tab. store in the original package in order to protect from moisture; store below 30°C	Alcohol: no special recommendation
Cefuroxime	Zinnat powder for oral susp. 125 mg/5 mL; 250 mg/5 mL	Powder for suspension: store in the original package, below 30°C Reconstituted susp.: store in a refrigerator (2–8°C); do not freeze After reconstitution, use the susp. within 10 days; shake the bottle vigorously before the medication is taken	Alcohol: no special recommendation
Cephalexin	Cap. Cefovit 250 mg; forte 500 mg Cap., tab. Cefalexin 250 mg; 500 mg Tab. Keflex 250 mg; 500 mg	Cap.: store in a dry place, below 25°C	Alcohol: no special recommendation
Cephalexin	Cefovit powder for oral susp. 125 mg/5 mL; Cefovit forte 250 mg/5 mL Cefalexin granules for oral susp. 125 mg/5 mL; 250 mg/5 mL Keflex granules for oral susp. 125 mg/5 mL; 250 mg/5 mL	Powder/granules for susp.: store in a dry place, below 25°C Reconstituted susp.: according to manufacturer instructions, store in a refrigerator (2–8°C) and use within 10–14 days^#; shake well before each use	Alcohol: no special recommendation
SMX-TMP	Caplets Diseptyl forte 800 mg/160 mg Tab. co-trimoxazole 400 mg/80 mg Tab. co-trimoxazole forte 800 mg/160 mg Tab. Septrin 400 mg/80 mg Tab. Septrin forte 800 mg/160 mg	Cap., tab.: store in the original package, below 25°C	Skin photosensitivity: as been reported with SMX-TMP; use with caution; use skin protection and avoid prolonged exposure to sunlight and ultraviolet light; avoid use of tanning equipment Discontinue the treatment if skin erythema occurs Alcohol: a disulfiram-like reaction (flushing, sweating, palpitations and drowsiness) may occur if alcohol (0.5–1 L of an alcoholic drink e.g. beer) is ingested
SMX-TMP	Susp. Diseptyl 200 mg/40 mg in 5 mL Co-trimoxazole paediatric susp. 200 mg/40 mg in 5 mL Co-trimoxazole adult susp. 400 mg/80 mg in 5 mL Septrin paediatric susp. 200 mg/40 mg in 5 mL Septrin adult susp. 400 mg/80 mg in 5 mL	Susp. Store in a dark and dry place, below 25°C Use within 10 days of opening^#.
Ciprofloxacin	Tab. Ciprodex 250 mg; 500 mg; 750 mg Tab. ciprofloxacin Teva 250 mg; 500 mg; 750 mg Ciprofloxacin 100 mg; 250 mg; 500 mg; 750 mg film-coated tab. Tab. Ciproxin 500 mg	Tab. store in the original package, below 25°C	Skin photosensitivity: ciprofloxacin has been shown to cause photosensitivity reactions; use skin protection and avoid prolonged exposure to sunlight and ultraviolet light; avoid use of tanning equipment Discontinue the treatment if skin erythema occurs Caffeine: ciprofloxacin has been shown to interfere with the metabolism of caffeine leading to increased caffeine concentrations; patients consuming regular large quantities of caffeinated beverages may need to restrict caffeine intake if excessive cardiac or central nervous system stimulation occurs; the effect of this interaction is greater in females
Ciprofloxacin	Ciproxin 250 mg/5 mL, granules and solvent for oral susp.	Ciproxin: store the granules and solvent below 25°C; protect the solvent from freezing; avoid inverted storage The ready-to-use oral susp. (utilising the individual components) is stable only for 14 days when either stored in a refrigerator (2–8°C) or at temperatures up to 30°C; protect the reconstituted susp. from freezing
Moxifloxacin	Tab. Megaxin 400 mg Tab., film-coated Moxicloxacin 400 mg Tab. Avelox 400 mg	Tab.: store in the original package in order to protect from moisture; store below 25°C	Skin photosensitivity: quinolones have been shown to cause photosensitivity reactions in patients; use skin protection and avoid prolonged exposure to sunlight and ultraviolet light; avoid use of tanning equipment Discontinue the treatment if skin erythema occurs
Fluconazole	Cap. Flucanol 50 mg; 100 mg; 150 mg; 200 mg Cap. fluconazole Teva 150 mg Cap. Trican 50 mg, 100 mg, 150 mg, 200 mg Cap. fluconazole/Azocan 50 mg, 150 mg, 200 mg	Cap.: store in a dry place below 25°C^#	Alcohol: no special recommendation
Fluconazole	Fluconazole powder for oral susp. (Genus Pharmaceuticals) 50 mg/5 mL Diflucan powder for oral suspension 10 mg/mL; 40 mg/mL	Powder for susp.: store in a dry place, below 25°C Reconstituted susp. store in a refrigerator (2–8°C) or at temperatures up to 30°C use within 14–28 days^#; protect the reconstituted susp. from freezing; shake well before administration	Alcohol: no special recommendation
Itraconazole	Cap. Itranol 100 mg Cap. itraconazole 100 mg	Cap.: store in the original package in order to protect from moisture; store below 25°C	Skin photosensitivity: uncommon (≤2%); case reports have been described Use skin protection and avoid prolonged exposure to sunlight and ultraviolet light; avoid use of tanning equipment Discontinue the treatment if skin erythema occurs Alcohol: no special recommendation
	Cap. Sporanox	Sporanox cap.: up to 30°C
	Sporanox oral solution 10 mg·mL⁻¹	Powder for susp.: store below 25°C; use within 30 days of opening
	Itraconazole 10 mg·mL⁻¹ oral solution
Expectorants and cough suppressants
Acetylcysteine	Reolin effervescent tablets 200 mg Siran 200 mg effervescent tablets	Effervescent tablets: store in the original package in order to protect from moisture; store below 25°C; close the tube immediately after taking out the tablet After dissolving the tablet, it must be used immediately Reolin: use within 2 years after the first opening or until the expiry date Siran: use within 4 weeks after the first opening	Alcohol: no special recommendation
Acetylcysteine	Sachet acetylcysteine 200 mg powder for oral solution	Powder for oral solution: store in the original package in order to protect from moisture Reconstituted solution: the product must be used immediately	Alcohol: no special recommendation
Guaifenesin	Resyl syrup 100 mg/5 mL (contains 6% alcohol by volume) Benylin syrup for children's chesty coughs 50 mg/5 mL Benylin syrup Mucus Cough Max honey and lemon flavour 100 mg/5 mL (contains 4.7% alcohol by volume) Oral solution Benylin Mucus Cough Max menthol flavour 100 mg/5 mL (contains 4.7% alcohol by volume) Boots chesty cough relief 100 mg/5 mL oral solution Boots chesty cough syrup 6 years plus (contains alcohol) Boots mucus cough relief 100 mg/5 mL oral solution Covonia chesty cough SF syrup Robitussin chesty cough medicine 100 mg/5mL⁻¹ oral solution (contains 2.7% v/v alcohol) Lemsip cough for chesty cough 50 mg/5 mL oral solution	Syrup: store in the original package, below 25°C Resyl: store below 30°C; use within 6 months of opening Benylin honey and lemon flavour: use within 6 months of opening Oral solution: store below 25°C Benylin menthol flavour: store in the original container to protect from light and use within 4 weeks of opening	Alcohol: some products contain alcohol; therefore, these formulations can emphasise the effect of sedatives (including alcohol) and myorelaxants Avoid concurrent use or use caution when motor skills are required
Other oral medications
Prednisone	Tab. prednisone 1 mg; 5 mg; 20 mg Modified-release tab. Lodotra 1 mg; 2 mg; 5 mg	Tab.: store in a dark and dry place, below 25°C Tab. prednisone 1 mg: use within 2 months of opening (but not after the expiry date) Lodotra: store below 25°C and use within 14 weeks of opening (but not after the expiry date)	Alcohol: no special recommendation
Prednisolone	Tab. Pevanti 2.5 mg; 5 mg; 10 mg; 20 mg; 25 mg Tab. prednisolone 1 mg, 2.5 mg; 5 mg; 10 mg; 20 mg; 25 mg; 30 mg Tab. prednisolone gastro-resistant 1 mg; 2.5 mg; 5 mg Soluble tab. prednisolone 5 mg	Tab. (also gastro-resistant and soluble tab.): store in the original package in order to protect from light and moisture, below 25°C Pevanti: use within 6 months of opening (but not after the expiry date)	Alcohol: some products contain alcohol; avoid concurrent use of ethanol with these formulations or use caution when motor skills are required
	Danalone syrup 15 mg/5 mL (contains alcohol)	Syrup: store below 25°C but not in the refrigerator; close firmly, and prevent penetration of air and moisture
	Prednisolone Dompe 1 mg·mL⁻¹ oral solution (single-dose containers) Prednisolone 10 mg·mL⁻¹ oral solution	Dompe: before opening, store in the original package; store below 30°C Once opened, the container must be discarded once the dose is removed Prednisolone 10 mg·mL⁻¹: keep the container in the outer carton in order to protect from light Before opening, store in a refrigerator (2–8°C) Once opened, store below 25°C and use within 3 months
Proton pump inhibitors
Omeprazole	Caplets Omepradex 10 mg; 20 mg; 40 mg Caplets Omepradex-Z 20 mg	Caplets: store in the original package, below 25°C	Skin photosensitivity: has been described but is rare (≤0.1%) Alcohol: no special recommendation
Omeprazole	Cap. Losec 20 mg (Israel) Cap. Omepra 10 mg; 20 mg; 40 mg Cap. Omeprix 20 mg Cap. Losec 10 mg; 20 mg; 40 mg (Europe) Cap. Mepradec gastro-resistant 10, 20 mg Cap. Omeprazole gastro-resistant 10 mg; 20 mg; 40 mg Cap. Prenome 10 mg; 20 mg; 40 mg Cap. Omeprazole 10 mg; 20 mg; 40 mg Tab. Omeprazole Gastro-resistant 10 mg; 20 mg; 40 mg Pyrocalm Control 20 mg gastro-resistant tablets	Cap., tab.: store below 25°C Store in the original package in order to protect from moisture, below 25–30°C and use within 3 months of opening of the bottle^#
Esomeprazole	Tab. esomeprazole Inovamed 20 mg; 40 mg Tab. Nexium 20 mg; 40 mg Tab. esomeprazole gastro-resistant 20 mg; 40 mg Cap. Emozul gastro-resistant 20 mg, 40 mg Cap. esomeprazole gastro-resistant 20 mg; 40 mg Ventra gastro-resistant capsules 20 mg; 40 mg	Tab., cap.: store in the original package in order to protect from moisture Store below 25–30°C^# and use within 3–6 months after first opening of the bottle^#	Skin photosensitivity: has been described in the literature but is rare (≤0.1%) Alcohol: no special recommendation
Esomeprazole	Sachet Nexium 10 mg gastro-resistant granules for oral susp.	Granules for oral susp.: use within 30 min after reconstitution
Lansoprazole	Cap. lansoprazole 15 mg; 30 mg Cap. Lanton 15 mg; 30 mg Cap. lansoprazole gastro-resistant 15 mg; 30 mg Orodispersible tab. lansoprazole 15 mg; 30 mg Zoton Fas-Tab 15 mg; 30 mg	Cap., tab.: store in the original package in order to protect from light and moisture; store below 25°C Use within 2 months to 100 days after first opening of the bottle^#	Skin photosensitivity: has been described in the literature but is rare (≤0.1%) Alcohol: no special recommendation
Pantoprazole	Tab. Contrololc 20 mg; 40 mg Pantoloc Control 20 mg gastro-resistant tablets Tab. Pantoprazole gastro-resistant 20 mg; 40 mg	Tab. store in the original package in order to protect from moisture; store below 25°C Use within 6 months after first opening of the bottle^#	Skin photosensitivity: has been described in the literature (but the frequency cannot be estimated from the available data); use with caution Alcohol: no special recommendation
H2 blockers
Famotidine	Tab. famotidine Teva 20 mg; 40 mg Tab. Famo 20 mg; 40 mg Tab. Gastro 10 mg; 20 mg; 40 mg Tab. Pepcid 20 mg; 40 mg	Tab. store in the original package in order to protect from light and moisture; store below 25°C	Alcohol: no special recommendation
Famotidine	Pepcid powder for oral susp. 40 mg/5 mL	Powder for susp.: store in the original package at 25°C; excursions permitted to 15–30°C Reconstituted susp.: after reconstitution, use the suspension within 30 days; protect from freezing	Alcohol: no special recommendation
Ranitidine	Tab. Zaridex 150 mg; 300 mg Tab. Ranitidine film-coated 150 mg; 300 mg Tab. Zantac 75 mg; 150 mg; 300 mg	Tab.: store in the original package, below 25°C	Alcohol: co-ingestion of alcohol (1.5–2 drinks) while on ranitidine may result in higher blood alcohol concentrations, although the clinical significance is uncertain In addition, some products contain alcohol; avoid concurrent use of ethanol with these formulations or use caution when motor skills are required
	Zantac syrup 150 mg/10 mL (contains ∼7.5% w/v alcohol)	Syrup: store below 25°C and use within 28 days of opening
	Ranitidine 150 mg/10 mL oral solution (contains ∼8% w/v alcohol) Ranitidine 30 mg·mL⁻¹ oral solution (contains ∼7.5% w/v alcohol)	Oral solution: store in original carton/bottle in order to protect from light; store below 25°C
Antacids
Aluminium hydroxide, magnesium hydroxide and dimethicone/simethicone	Maalox Plus chewable tablets (200 mg magnesium hydroxide, 200 mg hydrated aluminium oxide and 25 mg dimethicone in a tablet)	Tab.: store in the original package, below 25°C	Alcohol: no special recommendation
	Maalox Plus oral susp. (225 mg aluminium hydroxide, 200 mg magnesium hydroxide and 25 mg simethicone in 5 mL)	Oral susp.: store below 25°C and use within 28 days of opening; shake well before administration	Alcohol: no special recommendation
Calcium carbonate	Chewable tab. Tums Chewable tab. N-Zarevet Chewable tab.	Chewable tab.: store in the original package, below 25°C N-Zarevet: use within 12 months after first opening of the bottle	Alcohol: no special recommendation
Calcium carbonate and magnesium carbonate	Chewable tab. Rennie Chewable tab. Rolaids	Chewable tab.: store in the original package, below 25°C	Alcohol: no special recommendation
Calcium carbonate and magnesium carbonate	Rolaids mint liquid (550 mg calcium carbonate and 110 mg magnesium hydroxide in 5 mL)	Liquid: do not freeze	Alcohol: no special recommendation
Calcium carbonate, sodium bicarbonate and sodium alginate	Chewable tab. Gaviscon	Chewable tab.: store in the original package in order to protect from moisture; below 25–30°C^#	Alcohol: no special recommendation
	Gaviscon peppermint liquid	Liquid: store in the original package, below 25–30°C (according to manufacturer instructions) and use within 6 months of opening
	Gaviscon liquid sachets mint flavour (500 mg sodium alginate, 267 mg sodium bicarbonate and 160 mg calcium carbonate per 10-mL dose)	Liquid sachet: store in the original package, below 25°C; discard any unused contents
Bronchodilators: inhalers and solution
Salbutamol MDI	Ventolin inhaler CFC-Free 100 µg per dose Salbutrim CFC-free inhaler 100 µg per dose	Ventolin, Salbutrim: store below 30°C; protect from frost and direct sunlight If the inhaler gets very cold, take the metal container out of the plastic case and warm it in your hands for a few minutes; do not use anything else to warm it up	Alcohol: no special recommendation
	Easyhaler Salbutamol 100 µg per dose, 200 µg per dose Salamol Easi-Breathe 100 µg per dose	Easyhaler: store in a dry place, at a temperature below 25°C; use within 6 months after first opening of foil pouch
	Salbulin MDPI Novolizer	Salbulin: store below 30°C; use within 6 months after first opening the container
Ipratropium MDI	MDI Atrovent 20 µg per dose	MDI: store below 25°C (Europe) or 30°C (Israel); protect from frost and direct sunlight; do not expose to temperature >50°C	Alcohol: no special recommendation
Salbutamol (solution)	Ventolin respirator solution 5 mg·mL⁻¹ (0.5% w/v)	Ventolin respirator solution: store below 25–30°C^#; protect from light; discard any contents remaining 1 month after opening the bottle A fresh solution should be prepared before each usage	Alcohol: no special recommendation
Salbutamol (solution)	Ventolin Nebules 2.5 mg/2.5 mL (0.1% w/v), 5 mg/2.5 mL (0.2% w/v) Ampules Salbutamol 2.5 mg/2.5 mL nebuliser solution; 5 mg/2.5 mL	Ventolin Nebules, Ampules Salbutamol: store below 25–30°C^#; protect from light after removal from the foil overwrap pouch Use nebules 3 months after removal from the foil pouch; use immediately after first opening of the ampule and discard any unused contents	Alcohol: no special recommendation
Ipratropium (solution)	Aerovent respirator solution 0.25 mg·mL⁻¹	Respirator solution: store below 25°C; do not freeze Discard any contents remaining 1 month after opening the bottle A fresh solution should be prepared before each usage	Alcohol: no special recommendation
Ipratropium (solution)	Atrovent 250 UDVs, 1 mL; Atrovent UDVs, 2 mL–0.25 mg·mL⁻¹ vials Ampules ipratropium bromide 250 µg/1 mL nebuliser solution; 500 µg/2 mL nebuliser solution	Atrovent 250 UDVs, Atrovent UDVs, Ampules Ipratropium bromide: keep the vials in the outer carton; store below 25°C Use immediately after first opening of the ampule and discard any unused contents	Alcohol: no special recommendation
Other inhaled medications
Isotonic saline (sodium chloride 0.9% w/v)	Ampules sodium chloride 0.9% Fresenius 5 mL; 10 mL; 20 mL per ampule Saline nebuliser solution Arrow 2.5 mL per ampule Saline Steripoules 2.5 mL	Ampules: store below 25°C; do not refrigerate or freeze Saline nebuliser solution Strips of 10 ampules are overwrapped in an aluminium foil pack; ampules removed from the foil overwrap should be used within 90 days	Alcohol: no special recommendation
Hypertonic saline (sodium chloride 3%, 6%, 7% w/v)	INH Solution MucoClear (sodium chloride) 3%, 4 mL per ampule INH Solution MucoClear (sodium chloride) 6%, 4 mL per ampule	MucoClear: store below 25°C; do not refrigerate or freeze	Alcohol: no special recommendation
Hypertonic saline (sodium chloride 3%, 6%, 7% w/v)	INH Solution PulmoSal 7%, (pH+) 4 mL per vial	Pulmosal: store at room temperature, 15–30°C; avoid excessive heat and protect from freezing	Alcohol: no special recommendation
Inhaled antimicrobials
CMS	Vial Coliracin 1 000 000 units per vial Vial CMS 1 000 000 IU powder for solution for injection Vial Colomycin 1 000 000 IU, 2 million IU Promixin, 1 000 000 IU powder for nebuliser solution	Vial: store below 25°C; protect from light Use immediately after reconstitution with 0.9% sodium chloride; solutions may be used within 24 h when stored in a refrigerator (2–8°C)	Alcohol: no special recommendation
CMS	Colobreathe 1 662 500 IU inhalation powder, hard capsules (∼125 mg CMS)	Colobreathe: store in the original package until immediately before use in order to protect from moisture; store below 25°C	Alcohol: no special recommendation
Tobramycin	Vial tobramycin 40 mg·mL⁻¹ solution for injection	Vial for injection: store in the outer carton in order to protect from light; store below 25°C Use immediately after reconstitution with 0.9% sodium chloride Solutions may be used within 24 h when stored in a refrigerator (2–8°C) A fresh solution should be prepared before each usage	Alcohol: no special recommendation
	Vial Nebcin injection 40 mg·mL⁻¹	Ready-to-use nebuliser solution: store in the original package in order to protect from light and moisture; store in a refrigerator (2–8°C); do not freeze
	Bramitob 300 mg/4 mL nebuliser solution, single-dose container	The contents of the whole ampule should be used directly after opening; opened ampules should never be stored for re-use
	TOBI Podhaler 28 mg per capsule inhalation powder, hard capsules	TOBI pouch, Tymbrineb foil pouch, Tobramycin pouch (intact or opened); may be stored at room temperature (up to 25°C) for up to 28 days
	TOBI 300 mg/5 mL nebuliser solution, single-use ampule	Bramitob bags (intact or opened) may be stored at room temperature (up to 25°C) for up to 3 months Vantobra pouch (intact or opened) may be stored at room temperature (up to 25°C) for up to 4 weeks
	TOBI Podhaler 28 mg per capsule inhalation powder	Capsules for inhalation: TOBI Podhaler capsules must always be stored in the blister to protect from moisture and only removed immediately before use; store below 30°C Podhaler device: store the inhaler in its tightly closed case when not in use; each Podhaler device and its case are used for 7 days and then discarded and replaced
Gentamicin	Ampule gentamicin B. Braun 1 mg·mL⁻¹; 3 mg·mL⁻¹ solution for infusion Ampule gentamicin 10 mg·mL⁻¹ solution Ampule Genticin 40 mg·mL⁻¹ injectable Ampule Cidomycin 80 mg/2 mL solution for injection	Ampules for injection: store in the outer carton in order to protect from light; store below 25°C; use immediately after reconstitution with 0.9% sodium chloride; a fresh solution should be prepared before each usage	Alcohol: no special recommendation

Cap: capsules; tab: tablets: susp.: suspension; SF: sugar free; SR: sustained release; SMX: sulfamethoxazole; TMP: trimethoprim; MDI: metered-dose inhaler; CFC: chlorofluorocarbon; CMS: colistimethate sodium.^#: see leaflet, as different instructions for different manufacturers [23].