Bronchodilators

NHSL Medicines Guidance
NHS Lanarkshire

Short-Acting beta2 Agonist Bronchodilators (SABAs)

Preferred list (P)

SALBUTAMOL

  • Salbutamol is first-line due to costs.
Carbon footprint* Brand  Inhaler type
High Generic prescribing pMDI
Low Easyhaler Salbutamol® DPI (dry powder inhaler)

*Low (<35 g CO2e) or High (≥35 g CO2e) carbon footprint per puff

Reference:PrescQIPP Bulletin 295 [Accessed 28.4.23]

 

Total list (T)

TERBUTALINE

Carbon footprint* Brand Inhaler type
Low Bricanyl®Turbohaler® DPI 

*Low (<35 g CO2e) or High (≥35 g CO2e) carbon footprint per puff

Reference:PrescQIPP Bulletin 295 [Accessed 28.4.23]

Long-Acting beta2 Agonist Bronchodilators (LABAs)

Preferred list (P)

SALMETEROL

FORMOTEROL

Prescribing Notes:

  • Due to the increased mortality risk it is important that LABAs are used alongside inhaled corticosteroids for patients with asthma.

Long-Acting Muscarinic Antagonist Bronchodilators (LAMAs)

Preferred list (P)

TIOTROPIUM SOLUTION FOR INHALATION (Spiriva Respimat®)

Carbon footprint* Brand Inhaler type
Low Spiriva Respimat® SMI (soft mist inhaler) 

*Low (<35 g CO2e) or High (≥35 g CO2e) carbon footprint per puff

Reference:PrescQIPP Bulletin 295 [Accessed 28.4.23]

Prescribing Notes:

  • Monotherapy with LAMAs for COPD is no longer routinely recommended in NHS Lanarkshire; however existing patients whose symptoms are under control can continue on their current treatment until it is appropriate for them to change.
  • For further advice on the treatment of COPD and dosing regimens please see the NHSL Guidelines for the Pharmacological Management of COPD.
  • Use of LAMA monotherapy may be required where combination inhalers are not tolerated or contraindicated.
  • Inhalers should be prescribed by brand name.

Theophylline

Preferred list (P)

THEOPHYLLINE (Uniphyllin Continus®)

  • Prescribing by brand is recommended for oral formulations due to variations in bioavailability.

Prescribing Notes:

  • Intravenous aminophylline is not a recommended drug in primary care having been superseded by nebulised beta2–agonists.
  • Theophylline has a narrow margin between therapeutic and toxic effects; therapy should be monitored. For information relating to interactions see BNF for details.

Combination Bronchodilator Preparations for COPD: LAMA With LABA

Preferred list (P)

UMECLIDINIUM WITH VILANTEROL (Anoro Ellipta®)

GLYCOPYRRONIUM WITH FORMOTEROL FUMARATE (Bevespi Aerosphere®)

Carbon footprint* Brand Inhaler type
Low Anoro Ellipta® DPI
High Bevespi Aerosphere® pMDI

*Low (<35 g CO2e) or High (≥35 g CO2e) carbon footprint per puff

Reference:PrescQIPP Bulletin 295 [Accessed 28.4.23]

 

Total list (T)

TIOTROPIUM WITH OLODATEROL (Spiolto Respimat®)

Carbon footprint* Brand Inhaler type
Low Spiolto Respimat® DPI

*Low (<35 g CO2e) or High (≥35 g CO2e) carbon footprint per puff

Reference:PrescQIPP Bulletin 295 [Accessed 28.4.23]

Prescribing Notes:

 

NHSL Joint Adult Formulary Key

To indicate the category of a formulary medicine, updated sections adopt the following key:

Preferred list (P): First-line formulary choices.

Total list (T): Alternative choices when preferred list options not effective/not tolerated, or not indicated.

Specialist initiation (S1): Specialist initiation, or on the advice of a Consultant or Specialist Practitioner in this therapeutic area. Continuation in primary care is acceptable.

Specialist use only (S2): Supply via hospital, Homecare Service or a hospital based prescription (HBP) for dispensing by community pharmacy. Not prescribed in primary care setting.

Editorial Information

Last reviewed: 31/01/2022

Next review date: 31/01/2025

Author(s): NHSL.

Version: Please refer to the introduction section for an explanation of the review dates above.

Approved By: ADTC

Reviewer name(s): ADTC.