Inhaled short-acting beta2 agonists (SABA) (Formulary)

TAM (Treatments and Medicines) NHS Highland
NHS Highland
Information on inhaler technique can be found at Right Breathe and Asthma UK websites

SALBUTAMOL - (First line)

Therapy notes

  • MHRA advice: Short-acting beta 2 agonists (SABA) (salbutamol and terbutaline): reminder of the risks from overuse in asthma and to be aware of changes in the SABA prescribing guidelines
    (April 2025) (www.gov.uk).
    Advice for Healthcare Professionals:
    • excessive use of SABA to relieve acute asthma symptoms may mask progression of the underlying disease and contribute to an increased risk of severe and potentially life-threatening asthma exacerbations
    • do not prescribe SABA to people of any age with asthma without a concomitant prescription of an inhaled corticosteroid (see Asthma: diagnosis, monitoring and chronic asthma management (BTS, NICE, SIGN) NICE guideline [NG245], 2024)
    • ensure all patients with asthma receive optimal anti-inflammatory maintenance therapy even when their asthma is well controlled and that treatment is individualised to the patient
    • review and adjust asthma treatment in patients who take more than twice weekly “as needed” SABA
    • urgently review patients where there has either been an increase in the number of prescriptions requested for SABA reliever inhalers or a failure to collect prescribed anti-inflammatory maintenance treatment
    • anti-inflammatory reliever (AIR) therapy and maintenance and reliever therapy (MART) are recommended alternatives for people over 12 years of age with poorly controlled asthma
    • report suspected adverse drug reactions via the Yellow Card scheme

Asthma Guidance: 

For asthma, it is NO longer recommended that a SABA inhaler be prescribed alone, without a concomitant prescription for an ICS inhaler.

  • ALL patients should receive an ICS device on initiation of inhaled therapy.
  • Remind patients to rinse their mouth after using an ICS to avoid oral thrush. 

Formulation and dosage details

Formulation:

PREFERRED: Dry Powder Inhaler (DPI) (Inhalation powder)

These are more environmentally friendly than MDIs and should be considered first line providing that the patient shows good inhaler technique with the chosen device.

  • Easyhaler 100micrograms/dose (DPI)

Dosage:

By inhalation of powder, 100 to 200 micrograms (1 to 2 puffs) when required to relieve breathlessness. 

Formulation and dosage details

Formulation:

PREFERRED: Dry Powder Inhaler (DPI) (Inhalation powder)

These are more environmentally friendly than MDIs and should be considered first line providing that the patient shows good inhaler technique with the chosen device. 

  • Ventolin 200micrograms/dose Accuhaler (DPI)

Dosage:

By inhalation of powder: 200 to 400 micrograms (1 to 2 blisters) when required to relieve breathlessness.

Formulation and dosage details

Formulation:

ALTERNATIVE: Metered dose inhalers (MDI) (Pressurised inhalation)

To be considered in the small proportion of patients who are unable to use a DPI.

  • Salamol 100micrograms/dose inhaler CFC free (MDI)

Prescribe as the brand 'Salamol' as this has a lower environmental impact. 

Dosage:

By aerosol inhalation, 100 to 200 micrograms (1 to 2 puffs) when required to relieve breathlessness. 

Formulation and dosage details

Formulation:

Nebuliser solution 2·5mg/2·5mL, 5mg/2·5mL

Dosage:

By inhalation of nebulised solution, 2·5mg, repeated up to 4 times daily (see nebuliser notes).

MHRA advice: Nebulised asthma rescue therapy in children: home use of nebulisers in paediatric asthma should be initiated and managed only by specialists (August 2020) (www.gov.uk).

Editorial Information

Document Id: F343