3.1.1 Adrenoceptor agonists

Placebo inhalers can be obtained from the NEW Devon CCG Medicines Optimisation Team, please contact: d-ccg.medicinesoptimisation@nhs.net

Short-acting beta2 agonists (SABAs)

Salbutamol
  • Aerosol inhalation 100 micrograms/ metered inhalation (£1.50 = 200 doses)
  • Breath-actuated aerosol inhalation 100 micrograms/ metered inhalation (£6.30 = 200 doses)
  • Nebuliser liquid 1mg/ml, 2mg/ml, 5mg/ml (£2.18 = 20 x 5mg)
  • Oral solution 2mg/5ml (£1.15 = 150ml)
  • Injection 500 micrograms/ml
  • Solution for IV infusion (HDU/ITU only)

Indications

Dose

  • By aerosol inhalation, 100–200 micrograms (1–2 puffs); for persistent symptoms up to 4 times daily
  • Child: 100 micrograms (1 puff), increased to 200 micrograms (2 puffs) if necessary; for persistent symptoms up to 4 times daily
  • Prophylaxis of allergen or exercise-induced bronchospasm, 200 micrograms (2 puffs)
  • Child: 100 micrograms (1 puff), increased to 200 micrograms (2 puffs) if necessary

Notes

  1. Oral salbutamol is not generally recommended.
  2. If delivery of SABA via a spacer and face mask fails in children, usually calm persistence prevails; a home nebuliser may be considered in certain circumstances (see nebulisation guidance)
  3. Injections of beta2 agonists are only recommended for those patients unable to tolerate aminophylline infusion (use I/V salbutamol) or for a small number of brittle asthmatics (use S/C terbutaline).
Terbutaline
  • Dry powder inhaler 500 micrograms/ metered inhalation (£8.30 = 100 doses)
  • Nebuliser solution 2.5mg/ml (£4.04 = 20 units)
  • Injection 500 micrograms/ml

Indications

Dose

  • By inhalation of powder, adult and child over 5 years, 500 micrograms (1 inhalation); for persistent symptoms up to 4 times daily
  • By inhalation of nebulised solution, 5–10mg 2–4 times daily; additional doses may be necessary in severe acute asthma

Notes

  1. Injections of beta2 agonists are only recommended for those patients unable to tolerate aminophylline infusion (use I/V salbutamol) or for a small number of brittle asthmatics (use S/C terbutaline).
  2. See notes on nebulised therapy.

Long-acting beta2 agonists (LABAs)

In asthma, a LABA should only be prescribed as combination products with inhaled corticosteroids (see below).

Salmeterol
  • Soltel® aerosol inhalation 25 micrograms/ metered inhalation (£19.95 = 120 doses)
  • Dry powder for inhalation 50 micrograms/ blister (£35.11 = 60 blister unit)

Indications

Dose

  • COPD: 50 micrograms twice daily

Notes

  1. Soltel® CFC-free inhaler 25 micrograms contains soya lecithin and is contraindicated in patients who have peanut or soya allergies.
  2. In asthma, a LABA should only be prescribed as combination products with inhaled corticosteroids. Combination products are listed here.
Formoterol fumerate
  • Oxis Turbohaler® dry powder inhaler 6 micrograms/ metered inhalation, 12 micrograms/ metered inhalation (£24.80 = 120 doses)
  • Aerosol inhaler 12 micrograms/ metered inhalation (£30.06 = 100 dose unit)

Indications

Dose

  • COPD: 12 micrograms twice daily

Notes

  1. In asthma, a LABA should only be prescribed as combination products with inhaled corticosteroids. Combination products are listed here.
Indacaterol
  • Onbrez breezhaler® inhalation powder, hard capsule 150 micrograms, 300 micrograms (£32.19 = 30 caps)

Indications

Dose

  • 150 micrograms once daily, increased to maximum 300 micrograms once daily

Notes

  1. The commissioning of indacaterol inhalation powder hard capsules for inhalation is accepted in Devon for the maintenance treatment of patients with Chronic Obstructive Pulmonary Disease (COPD) who require a long acting bronchodilator (see Commissioning Policy for more details).

 

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