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3.1.1 Adrenoceptor agonists

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

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

ChoiceDrugCarbon FootprintDose Counter Present (D)

Prescribe DPIs by brand name

Salbutamol DPI

(Refer to BNF for full list of salbutamol DPI products e.g. Easyhaler® Salbutamol, Salbulin® Novolizer, Ventolin Accuhaler®)

D
or

Terbutaline DPI

Bricanyl Turbohaler® DPI 500 micrograms/metered inhalation

D

If MDI required:

Salbutamol MDI:

Salamol® (MDI) 100micrograms/metered inhalation

or

Salamol Easi-Breathe® (breath-actuated MDI) 100micrograms/metered inhalation

Symbol Carbon indicator

Low Carbon Footprint (<2kg CO2e per inhaler)

High Carbon Footprint (6-20kg CO2e per inhaler)

Highest Carbon Footprint (>34kg CO2e per inhaler)

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

  • Prescribing three or more SABA inhalers per year is associated with an increased risk of severe exacerbations and mortality, and reflects very poorly controlled asthma. Asthma patients prescribed three or more SABA inhalers in the previous 12 months should be prioritised for review.

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