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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.

ChoiceDrugDosage

Formulary choices

Salbutamol DPI

For DPI preparations and doses see BNF. Prescribe DPIs by brand name.
or
Terbutaline DPI 500 micrograms/metered inhalationDose: 500micrograms up to 4 times daily
Prescribe DPIs by brand name
or
If a MDI is requiredSalamol® (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.

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 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/doseDose:
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 inhalationDose:
50 micrograms twice daily