3.1.1 Adrenoceptor agonists
Click here for long-acting beta 2 agonists (LABA).
Short-acting beta 2 agonists (SABA) [Asthma and COPD]
Salbutamol (MDI) or breath-actuated MDI;
|Salbutamol DPI||For DPI preparations and doses see BNF. |
Prescribe DPIs by brand name
|Terbutaline DPI 500 micrograms/metered inhalation:||Dose: 500micrograms up to 4 times daily Prescribe DPIs by brand name|
- 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.
- 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]
|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||Formoterol 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
For DPI preparations and doses see BNF
|Salmeterol MDI 25micrograms/metered inhalation; |
Salmeterol DPI 50micrograms/dose
50micrograms twice daily