Respiratory medicines/devices key summaries
Drug MOA Notes
SABA e.g Salbutamol (QDS PRN), Beta receptor agonist Short-acting inhaled
terbutaline (QDS PRN) bronchodilator ~ 3 – 5 hours.
‘blue inhaler’ See Gp if salbutamol fails to
provide relief within 3 hours.
Alternatives to SABA: SAMA
(ipratropium bromide), if 12+:
theophylline or oral b2 agonist
(bambuterol)
Corticosteroids e.g. Anti-inflammatory Inhaled corticosteroids are used
beclomethasone (BD), as maintenance preventer
budesonide (BD), fluticasone therapy: start bd can reduce to
(BD), mometasone (BD/OD), od if good control
ciclesonide (OD) Oral or intravenous
‘brown inhaler’ corticosteroids are used
following an acute exacerbation
of asthma or COPD
Beclomethasone CFC – free
inhalers
Rx beclomethasone cfc-free by
brand: e.g. Qvar & clenil not
interchangeable
Fostair
(beclometasone/formoterol)>
Qvar> traditional CFC
containing beclomethasone
inhalers e.g clenil (most potent
to least potent)
Easyhaler 18+, Qvar 12+, Clenil
200/250 12+
Ses: hoarse voice, sore throat,
candidiasis (rinse mouth,
spacer, can treat with
miconazole not with warfarin;
alternative: nystatin (POM)),
bronchospasm (mild: consider
switching from pmdi to dpi)
NICE: Use a pmdi + spacer with
high dose ics & in < 15s; pMDI +
spacer with face mask in < 5s
Fostair: keep refrigerated
Alternatives: LTRA,
theophylline, inhaled sodium
cromoglicate, inhaled
nedocromil
SAMA e.g. ipratropium bromide Blocks the muscarinic Short-acting inhaled
(TDS) acetylcholine receptors bronchodilator. Relaxes
bronchial smooth muscle
Used primarily in COPD – for
, short term relief
Tiotropium has similar effects
but is long-acting
Caution: prostatic hyperplasia,
glaucoma (protect eyes)
Antimuscarinic ses: dry mouth
(most common), bronchospasm
LABA e.g. formoterol (BD), Beta receptor agonist Long acting inhaled
salmeterol (BD), olodaterol (in bronchodilator ~12 hours
adults - specifically licensed for In asthma: LABAs to be used
COPD; striverdi), indacaterol (in with ICS not alone, do not
adults - specifically licensed for initiate if rapidly deteriorating;
COPD; onbrez), vilanterol (with used in nocturnal asthma due to
umeclidinium - specifically long action
licensed for COPD; anoro/ with Salmeterol (long onset + long
fluticasone - asthma) action): not for acute relief
Formoterol (short onset + long
action): used as both preventer
and reliever, useful in poorly
controlled asthma, if used more
than once daily as a reliever -
need to be reviewed by dr
Brands: fostair, duoresp
spiromax, symbicort (18+ years)
Ses: hand tremors, tachycardia,
hyperglycaemia, hypokalaemia
(high risk in severe asthma with
concomitant use of steroids,
theophylline, b2 agonists),
serious cvd
Pt counselling: clearly state
dose, frequency and max puffs
in 24 hours
LAMA e.g. tiotropium (spiriva; Blocks the muscarinic Long acting maintenance
respimat licensed as adjunct to acetylcholine receptors therapy
laba/ics in asthma with 1 or LABA/LAMA combinations are
more severe exacerbation in available
past year), aclidinium (eklira -
bd), glycopyronnium (seebri -
od), umeclidinium (incruse - od)
Methylxanthines e.g. Non-specific inhibitor of Used in asthma and
theophylline, aminophylline (= phosphodiesterase resulting in uncontrolled copd
theophylline + ethylenediamine) an increase in cAMP Given orally or intravenously
Aminophylline: too irritant to
give IM - highly soluble iv
(choice)
narrow therapeutic range
Prescribe by brand
Interactions: plasma conc
increased– hf, hepatic
impairment, viral infection,
Drug MOA Notes
SABA e.g Salbutamol (QDS PRN), Beta receptor agonist Short-acting inhaled
terbutaline (QDS PRN) bronchodilator ~ 3 – 5 hours.
‘blue inhaler’ See Gp if salbutamol fails to
provide relief within 3 hours.
Alternatives to SABA: SAMA
(ipratropium bromide), if 12+:
theophylline or oral b2 agonist
(bambuterol)
Corticosteroids e.g. Anti-inflammatory Inhaled corticosteroids are used
beclomethasone (BD), as maintenance preventer
budesonide (BD), fluticasone therapy: start bd can reduce to
(BD), mometasone (BD/OD), od if good control
ciclesonide (OD) Oral or intravenous
‘brown inhaler’ corticosteroids are used
following an acute exacerbation
of asthma or COPD
Beclomethasone CFC – free
inhalers
Rx beclomethasone cfc-free by
brand: e.g. Qvar & clenil not
interchangeable
Fostair
(beclometasone/formoterol)>
Qvar> traditional CFC
containing beclomethasone
inhalers e.g clenil (most potent
to least potent)
Easyhaler 18+, Qvar 12+, Clenil
200/250 12+
Ses: hoarse voice, sore throat,
candidiasis (rinse mouth,
spacer, can treat with
miconazole not with warfarin;
alternative: nystatin (POM)),
bronchospasm (mild: consider
switching from pmdi to dpi)
NICE: Use a pmdi + spacer with
high dose ics & in < 15s; pMDI +
spacer with face mask in < 5s
Fostair: keep refrigerated
Alternatives: LTRA,
theophylline, inhaled sodium
cromoglicate, inhaled
nedocromil
SAMA e.g. ipratropium bromide Blocks the muscarinic Short-acting inhaled
(TDS) acetylcholine receptors bronchodilator. Relaxes
bronchial smooth muscle
Used primarily in COPD – for
, short term relief
Tiotropium has similar effects
but is long-acting
Caution: prostatic hyperplasia,
glaucoma (protect eyes)
Antimuscarinic ses: dry mouth
(most common), bronchospasm
LABA e.g. formoterol (BD), Beta receptor agonist Long acting inhaled
salmeterol (BD), olodaterol (in bronchodilator ~12 hours
adults - specifically licensed for In asthma: LABAs to be used
COPD; striverdi), indacaterol (in with ICS not alone, do not
adults - specifically licensed for initiate if rapidly deteriorating;
COPD; onbrez), vilanterol (with used in nocturnal asthma due to
umeclidinium - specifically long action
licensed for COPD; anoro/ with Salmeterol (long onset + long
fluticasone - asthma) action): not for acute relief
Formoterol (short onset + long
action): used as both preventer
and reliever, useful in poorly
controlled asthma, if used more
than once daily as a reliever -
need to be reviewed by dr
Brands: fostair, duoresp
spiromax, symbicort (18+ years)
Ses: hand tremors, tachycardia,
hyperglycaemia, hypokalaemia
(high risk in severe asthma with
concomitant use of steroids,
theophylline, b2 agonists),
serious cvd
Pt counselling: clearly state
dose, frequency and max puffs
in 24 hours
LAMA e.g. tiotropium (spiriva; Blocks the muscarinic Long acting maintenance
respimat licensed as adjunct to acetylcholine receptors therapy
laba/ics in asthma with 1 or LABA/LAMA combinations are
more severe exacerbation in available
past year), aclidinium (eklira -
bd), glycopyronnium (seebri -
od), umeclidinium (incruse - od)
Methylxanthines e.g. Non-specific inhibitor of Used in asthma and
theophylline, aminophylline (= phosphodiesterase resulting in uncontrolled copd
theophylline + ethylenediamine) an increase in cAMP Given orally or intravenously
Aminophylline: too irritant to
give IM - highly soluble iv
(choice)
narrow therapeutic range
Prescribe by brand
Interactions: plasma conc
increased– hf, hepatic
impairment, viral infection,
