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.
Choice | Drug | Dosage |
---|---|---|
Formulary choices | Salbutamol DPI | For DPI preparations and doses see BNF. Prescribe DPIs by brand name. |
or | ||
Terbutaline DPI 500 micrograms/metered inhalation | Dose: 500micrograms up to 4 times daily Prescribe DPIs by brand name | |
or | ||
If a MDI is required | Salamol® (MDI) 100micrograms/ metered inhalation (salbutamol) | Dose:100–200micrograms up to 3–4 times daily; prophylaxis in exercise–induced bronchospasm, 200micrograms |
or | ||
Salamol®Easi-breathe (breath-actuated MDI) 100micrograms/ metered inhalation (salbutamol) | Dose:100–200micrograms up to 3–4 times daily; prophylaxis in exercise–induced bronchospasm, 200micrograms | |
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.
Choice | Drug | Dosage |
---|---|---|
NB – in asthma, LABAs should only be started in patients who are already on inhaled corticosteroids, and the inhaled corticosteroid should be continued (combination devices are recommended) | ||
Formulary choices If a MDI is required | Formoterol DPI NB Formoterol Easyhaler® is a cost-effective choice | For DPI preparations and doses see BNF |
or | ||
Salmeterol DPI 50micrograms/dose | Dose: 50 micrograms twice daily | |
or | ||
Formoterol fumarate MDI 12micrograms/metered inhalation or | Dose: 12 micrograms twice daily (max. per dose 24 micrograms), for symptom relief additional doses may be taken to maximum daily dose; maximum 48 micrograms per day | |
Salmeterol MDI 25micrograms/metered inhalation | Dose: 50 micrograms twice daily |