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.


Choice	Drug	Carbon Footprint	Dose 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)

General

There is no substantial 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 repeating a supply of SABA inhaler.
Low carbon prescribing: Offer dry powder inhalers (DPIs) as first choice when clinically appropriate. If a metered dose inhaler (MDI) is required chose a brand with a lower carbon footprint, e.g. Salamol^® 100 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.