Notes for: Selective Beta(2)-AgonistsLast edited [22/08/2013 16:01:26]
Short acting agents:
1. Acute attacks: Salbutamol delivered via an MDI and spacer device is an effective alternative to nebulised salbutamol for acute attacks and is less likely to cause salbutamol-induced transient hypoxaemia. For adults, the dose required is 4 puffs of salbutamol (100 micrograms per dose) via MDI plus spacer approximately every 15 minutes. This may be repeated up to four times per hour. For young children the dose is up to 10 puffs (1 puff every 15 - 30 seconds).
2. Oral salbutamol should only be used in Step 4 of the management of asthma in adults (tablets) or in children unable to use any form of inhalation device, including paediatric spacer with facemask (oral solution). The tablets can also be used to inhibit premature birth.
3. In acute management injections of beta agonists should only be used for those patients in who inhaled therapy cannot be used reliably.
Last edited [22/08/2013 16:02:52]
Long acting agents:
1. Long acting bronchodilators such as formoterol and salmeterol are recommended in addition to standard dose inhaled steroids (200 - 800 micrograms beclometasone or equivalent per day) at step 3 for adults and school children. They should be tried before titrating inhaled corticosteroids into the high dose range (800 - 2000 micrograms beclometasone / day). They should be discontinued if no demonstrable evidence of benefit. Long acting bronchodilators are not recommended in children under 5 years old.
2. To ensure safe use, MHRA has advised that for the management of chronic asthma, long-acting beta2 agonists (formoterol and salmeterol) should:
- be added only if regular use of standard dose inhaled corticosteroids has failed to control asthma adequately;
- not be initiated in patients with rapidly deteriorating asthma;
- be introduced at a low dose and the effect properly monitored before considering dose increase;
- be discontinued in the absence of benefit;
- be reviewed as clinically appropriate: stepping down therapy should beconsidered when good long-term asthma control has been achieved.
Patients should be advised to report any deterioration in symptoms following initiation of treatment with a long-acting beta2 agonist.