3.1.1 Adrenoceptor agonists

General guidance

• Short acting agents should not be prescribed on a regular basis in patients with mild or moderate asthma.
• If beta2-adrenoceptor agonist inhalation is needed more than once daily prophylactic treatment with an inhaled corticosteroid, using a stepped approach as outlined on the previous page, is the more appropriate than increasing beta2-agonist dose frequency.
• Inhalation is preferred to administration by tablets or oral liquid since it provides more rapid relief and causes fewer adverse effects. Oral medication has often been used in the past especially for children. However, even small infants can be given MDIs through large volume spacer devices with or without a mask. Oral preparations containing ephedrine or orciprenaline should be avoided.
• The dose in terms of the number of inhalations at one time, the frequency, and the maximum number of inhalations allowed in 24 hours should be stated explicitly to the patient.
• Long acting beta2-agonists should only be added to existing corticosteroid therapy – they are not a replacement for it.

Recommended drugs

Short acting agent

Salbutamol £

Terbutaline £

Long acting agent

Salmeterol MDI £££

Formoterol Turbohaler £££

Drug Traffic Light Key:

Green – On Formulary

Amber – Restricted use, see local guidelines      

Purple – Specialist use/initiation

Red – Non Formulary

Relative Costs Key (where indicated):

£££££ - high

£££ - moderate

£ - low