Short-acting bronchodilator therapy for COPD

Short-acting bronchodilator therapy is used as required to provide short-term symptom relief for patients with COPD. There is no evidence that short-acting bronchodilator therapy reduces the rate of decline in lung function or has any effect on survival. For patients with mild and infrequent symptoms, a combination of general measures and short-acting beta2 agonist (SABA) bronchodilator therapy may be adequate.

For as-required therapy, use:

1 salbutamol 100 to 200 micrograms by inhalation via pMDI with spacer, as required (see Inhalers available in Australia for COPD for regimen expressed as number of inhalations) chronic obstructive pulmonary disease, maintenance salbutamol    

OR

1 terbutaline 500 micrograms by inhalation via DPI, as required (see Inhalers available in Australia for COPD for regimen expressed as number of inhalations). chronic obstructive pulmonary disease, maintenance terbutaline    

A nebuliser is only necessary for patients who are unable to use a pMDI or a DPI.

Ipratropium is not usually used for symptom relief in COPD—it is contraindicated in patients taking a long-acting muscarinic antagonist (LAMA), is more expensive than a SABA, and may increase the risk of cardiovascular events.

Assess response 3 months after starting treatment. In patients who remain symptomatic, check inhaler technique before considering stepping up to long-acting bronchodilator (LABA or LAMA) monotherapy.