3.1. Bronchodilators
The British Thoracic Society and the Scottish Intercollegiate Guidelines Network jointly produce the British Guideline on the Managment of Asthma which are available from the SIGN website (www.sign.ac.uk). Nebules should generally be used as an emergency back-up to other treatments rather than used routinely. The prescribing resources page contains useful resources for prescribing inhaler devices including device guides and patient information leaflets.3.1.1. Adrenoceptor agonists
3.1.1.1. Selective beta2 agonists
3.1.1.1.1. Short-acting bronchodilators
Where a patient can use it, a metered dose inhaler (MDI) is the device of choice based on cost.Prescribing Notes:
Preferred devices:
- 1st choice: Salbutamol 100 microgram MDI (with or without spacer device)
- 2nd choice: Salbutamol 100 microgram Easyhaler
Salbutamol inhalers generally should not be prescribed to be used regularly, but should be used on a when required basis. Metered-dose inhalers (MDIs) are the most cost-effective devices
Prescribing Notes:
Nebules should generally be used as an emergency back-up to other treatments rather than used routinely.
Prescribing Notes:
Salbutamol inhalers generally should not be prescribed to be used regularly, but should be used on a when required basis. Metered-dose inhalers (MDIs) are the most cost-effective devices
Prescribing Notes:
To prevent confusion, prescribe inhaler devices by brand name.
Nebules should generally only be used as an emergency back-up to other treatments rather than used routinely.
3.1.1.1.2. Long-acting bronchodilators
In asthma, at step 3 in the BTS/SIGN guidelines, inhaled long-acting beta2 agonists are recommended as first line add-on therapy. A long-acting beta agonist would not normally be prescribed in addition to a steroid and bronchodilator combination device.Prescribing Notes:
Preferred brands and devices:
- 1st Choice: Formoterol Easyhaler (dry powder inhaler)
- 2nd Choice: Atimos Modulite (aerosol inhaler)
To prevent confusion, prescribe inhaler devices by brand name.
3.1.1.1.3. Combination inhaled devices
3.1.1.2. Other adrenoceptor agonists
3.1.2. Antimuscarinic bronchodilators
3.1.2.1. Antimuscarinic combination inhalers
Restrictions:
For use as a maintenance bronchodilator in COPD. To prevent confusion, prescribe inhaler devices by brand name. Preferred List use of tiotropium only relates to use in COPD. For restrictions on use in asthma, see the entry in the Total Formulary.
Prescribing Notes:
Preferred brand and device:
- Braltus® Zonda
To prevent confusion, prescribe inhaler devices by brand name.
Prescribing Notes:
To prevent confusion, prescribe inhaler devices by brand name.
For the relevant SMC advice click here
Restrictions:
COPD
- Use as a maintenance bronchodilator in COPD when other tiotropium preparations (see Preferred List) are not suitable.
Asthma
- The use in adults with asthma is restricted to initiation by clinicians experienced in the management of asthma as add-on treatment in adults at step 4 with poorly controlled asthma (at least one course of oral steroids for a severe exacerbation in the last year) who have persistent airflow obstruction (post-bronchodilator FEV1 of less than 80% predicted).
Prescribing Notes:
To prevent confusion, prescribe inhaler devices by brand name.