Bronchodilators

NHSL Medicines Guidance
NHS Lanarkshire

Short-Acting beta2 Agonist Bronchodilators (SABAs)

Information for Prescribers: Update to Adult Asthma Guidelines (May 2025)

NHS Lanarkshire has updated its guidance on the Pharmacological Management of Adult Asthma in Primary & Secondary Care. The revised guideline recommends two treatment pathways for newly diagnosed or symptomatic asthma patients:

  • Anti-Inflammatory Reliever (AIR)
  • Maintenance and Reliever Therapy (MART)

Both pathways use combination inhalers containing an inhaled corticosteroid (ICS) and formoterol, and do not include short-acting beta agonists (SABAs) as reliever inhalers for asthma. The SABA inhalers below remain as preferred formulary options for COPD management.

Patients who are stable, asymptomatic, and satisfied with their current traditional treatment should not be switched to these new pathways unless there is another reason to change therapy. Formulary choices for the traditional treatment pathway are listed below.

Preferred list (P)

Lanarkshire Preferred formulary SABA Reliever inhalers for use within the traditional adult asthma treatment pathway and for COPD management.

SALBUTAMOL

Brand  Inhaler type Carbon footprint*
Generic prescribing 100mcg pMDI High
Easyhaler Salbutamol® 200mcg DPI  Low

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

Reference:PrescQIPP Bulletin 295 [Accessed 03.09.2025]

 

Total list (T)

TERBUTALINE

  • Lanarkshire Total formulary option SABA inhaler for COPD management.
  • Bricanyl Turbohaler® is no longer a formulary option for management of Asthma. 
Brand Inhaler type Carbon footprint*
Bricanyl Turbohaler® DPI  Low

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

Reference:PrescQIPP Bulletin 295 [Accessed 03.09.2025]

Long-Acting beta2 Agonist Bronchodilators (LABAs)

Long-Acting beta2 Agonist Bronchodilators (LABAs) are no longer recommended in NHS Lanarkshire in the pharmacological management of Adult COPD or Asthma. Updated guidelines are linked below:

Long-Acting Muscarinic Antagonist Bronchodilators (LAMAs)

Preferred list (P)

TIOTROPIUM SOLUTION FOR INHALATION (Spiriva Respimat®)

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

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

Reference:PrescQIPP Bulletin 295 [Accessed 03.09.2025]

Prescribing Notes:

  • LAMA therapy is included in the NHS Lanarkshire 'Pharmacological Management of Adult Asthma in Primary & Secondary Care' guideline as add-on treatment when neither FeNO nor blood eosinophil count is raised. This add on therapy should be prescribed on a trial basis and discontinued if there is no clinical benefit after 8-12 weeks.
  • 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 Guideline for the Pharmacological Management of COPD.
  • 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:

  • In NHS Lanarkshire, theophylline is no longer recommended for use in Asthma and only remains a treatment option in the NHSL Guideline for the Pharmacological Management of COPD.
  • Theophylline has a narrow margin between therapeutic and toxic effects; therapy should be monitored. For information relating to interactions see BNF for details.
  • Intravenous aminophylline is not a recommended drug in primary care having been superseded by nebulised beta2–agonists.

Combination Bronchodilator Preparations for COPD: LAMA With LABA

Preferred list (P)

UMECLIDINIUM WITH VILANTEROL (Anoro Ellipta®)

GLYCOPYRRONIUM WITH FORMOTEROL FUMARATE (Bevespi Aerosphere®)

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

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

Reference:PrescQIPP Bulletin 295 [Accessed 03.09.2025]

 

Total list (T)

TIOTROPIUM WITH OLODATEROL (Spiolto Respimat®)

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

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

Reference:PrescQIPP Bulletin 295 [Accessed 03.09.2025]

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: 22/10/2025

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.