3.1.1 Adrenoceptor agonists

Click here for long-acting beta 2 agonists (LABA).

Short-acting beta 2 agonists (SABA) [Asthma and COPD]

Prescribe an inhaler with a lower carbon impact where possible  – resources can be found here.

Prescribing Notes

General

• There is virtually no difference in efficacy between salbutamol and terbutaline; currently salbutamol is less expensive and available in a wider range of devices.
• A respiratory disease diagnosis should be made before putting SABA inhaler on repeat prescription.
• Offer Dry Powder Inhalers (DPIs) as first choice when clinically appropriate. If a MDI is required chose a brand with a lower carbon footprint e.g. Salamol^® inhaler CFC free (MDI)
• Oral beta 2 agonists have an increased risk of side-effects and should only be prescribed in exceptional cases where inhaled therapies cannot be used. Patients currently prescribed oral beta 2 agonists should be reviewed and a switch to inhaled therapy considered.

Asthma

• SABAs should only be prescribed on a “when required” basis for rescue therapy.
• Inhaled corticosteroids should be considered for patients with any of the following asthma-related features:
  • asthma attack in the last two years
  • using inhaled SABA three times a week or more
  • symptomatic three times a week or more
  • waking one night a week with respiratory symptoms
• Asthma patients prescribed more than 12 short-acting reliever inhalers in the previous 12 months should be invited for urgent review (National Review of Asthma Deaths recommendation).

Long-acting beta 2 agonists (LABA) [COPD only]

Prescribe an inhaler with a lower carbon impact where possible  – resources can be found here.