3.1.1 Adrenoceptor agonists

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

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

ChoiceDrugDosage
Formulary choices

Salbutamol (MDI) or breath-actuated MDI;
100micrograms/metered inhalation

Dose:
100–200micrograms up to 3–4 times daily; prophylaxis in exercise–induced bronchospasm, 200micrograms

Salbutamol DPIFor 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

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.
  • 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]

ChoiceDrugDosage
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 choicesFormoterol fumarate MDI 12micrograms/metered inhalation;

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

Formoterol DPI

NB Formoterol Easyhaler® is a cost-effective choice

For DPI preparations and doses see BNF

Or
Salmeterol MDI 25micrograms/metered inhalation;
Salmeterol DPI 50micrograms/dose
Dose:
50micrograms twice daily