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

Generic prescribing of inhalers should be avoided as this might lead to people with asthma being given an unfamiliar inhaler device which they are not able to use properly; in addition, not all inhalers with the same primary ingredient are interchangeable due to differences in particle size.

Different products and doses are licensed for different age groups and some may be applicable only to older children or adults (aged 18 years and over). Prior to prescribing, the relevant Summary of Product Characteristics (SPC) should be checked.

MDI = Metered dose inhaler; DPI = Dry powder inhaler

When prescribing a pressurised MDI, remind patients to check and remove the mouthpiece cover properly before inhaling a dose and to shake the inhaler to remove loose objects that may have become trapped in the inhaler during storage. The mouthpiece cover should be replaced securely after use. See MHRA Drug Safety Alert July 2018 for further details

Short-acting beta2 agonists (SABAs)

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

Indications

Dose

  • Adults, by aerosol inhalation: 100–200 micrograms (1–2 puffs); for persistent symptoms up to 4 times daily
  • Child, by aerosol inhalation: 100-200 micrograms (1-2 puffs); for persistent symptoms up to 4 times daily
  • Adults, by aerosol inhalation, prophylaxis of allergen or exercise-induced bronchospasm: 200 micrograms (2 puffs)
  • Adults, inhalation of nebulised solution: 2.5–5 mg, repeated up to 4 times daily or more frequently in severe cases.

Notes

  1. 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)
  2. 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
  • Bricanyl® Turbohaler® Dry powder inhaler 500 micrograms/ metered inhalation (DPI) (£8.30 = 100 doses)
  • Nebuliser solution 2.5mg in 1ml (£4.04 = 20 units)
  • Injection 500 micrograms in 1ml

Indications

Dose

  • Adult and child over 5 years by inhalation of powder: 500 micrograms (1 inhalation); for persistent symptoms up to 4 times daily
  • Adults, 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, LABAs should only be prescribed as combination products with inhaled corticosteroids

Salmeterol
  • Soltel® aerosol inhalation 25 micrograms/ metered dose inhalation (MDI) (£29.26 = 120 doses)
  • Serevent Accuhaler® Dry powder for inhalation 50 micrograms/ blister (DPI) (£35.11 = 60 dose 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, LABAs should only be prescribed as combination products with inhaled corticosteroids. Combination products are listed here.
Formoterol fumerate
  • Oxis® Turbohaler® dry powder inhaler 6 micrograms/dose, 12 micrograms/dose (DPI) (£24.80 = 60 dose unit)
  • Atimos Modulite® Aerosol inhalation 12 micrograms/dose (MDI) (£30.06 = 100 dose unit)

Indications

Dose

  • COPD: 12 micrograms twice daily

Notes

  1. In asthma, LABAs 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 (DPI) (£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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