GP RESP PHARMACOLOGY

Tiotropium

drug class: Long-acting muscarinic antagonist (LAMA); antimuscarinic bronchodilator. uses: Maintenance treatment of COPD; add-on maintenance treatment for selected patients with asthma. side effects: Dry mouth, constipation, urinary retention and blurred vision. important cautions: Not a rescue inhaler for sudden breathlessness. Avoid spraying into the eyes; use caution in glaucoma and urinary retention. In asthma, use as an add-on to appropriate inhaled corticosteroid-containing treatment.

Salbutamol

drug class: Short-acting beta-2 agonist (SABA); bronchodilator. uses: Rapid relief of bronchospasm in asthma and COPD; prevention of exercise-induced symptoms. side effects: Tremor, palpitations, tachycardia, headache and muscle cramps; high doses may cause hypokalaemia. important cautions: Frequent need for a reliever suggests poor control and requires clinical review. Excessive use can cause cardiovascular effects. Follow the prescribed asthma action plan.

Formoterol

drug class: Long-acting beta-2 agonist (LABA). uses: Maintenance bronchodilation in asthma and COPD; in specific inhalers combined with an inhaled corticosteroid, it may also be used as a reliever. side effects: Tremor, palpitations, headache and tachycardia. important cautions: In asthma, do not use LABA without inhaled corticosteroid treatment. Only certain ICS/formoterol products and regimens are suitable for reliever use; follow the prescribed plan.

Salmeterol

drug class: LABA. uses: Maintenance treatment of asthma and COPD. side effects: Tremor, palpitations, headache and muscle cramps. important cautions: In asthma, never use without an inhaled corticosteroid. It is not a rapid-relief inhaler for acute bronchospasm. Check inhaler technique and adherence if symptoms persist.

Beclometasone (inhaled)

drug class: Inhaled corticosteroid (ICS). uses: Prevention and long-term control of asthma; selected inhaled products are used in COPD combination regimens. side effects: Oral candidiasis, hoarseness and throat irritation; high doses or prolonged use can cause systemic steroid effects. important cautions: Not usually for immediate relief of an acute attack. Rinse the mouth after use and use a spacer when appropriate. Do not stop long-term treatment without clinical advice.

Budesonide (inhaled)

drug class: ICS. uses: Asthma maintenance; also used in some COPD combination inhalers and specific other indications. side effects: Oral candidiasis, hoarseness and throat irritation; high-dose prolonged use can cause adrenal suppression and other systemic effects. important cautions: Rinse the mouth after inhalation. Some budesonide/formoterol inhalers can be prescribed for both maintenance and relief; follow the exact prescribed regimen.

Fluticasone (inhaled)

drug class: ICS. uses: Long-term control of asthma; selected formulations are used in COPD combination treatment. side effects: Oral candidiasis, hoarseness and throat irritation; systemic corticosteroid effects with high doses or prolonged use. important cautions: Rinse the mouth after use. Not a stand-alone rescue treatment for sudden breathlessness. Review dose and technique if adverse effects or poor control occur.

Beclometasone (nasal)

drug class: Intranasal corticosteroid. uses: Allergic rhinitis and nasal inflammation. side effects: Nasal irritation, dryness, nosebleeds and sore throat. important cautions: Aim the spray away from the nasal septum to reduce bleeding. Regular use may be needed for full benefit. Review persistent bleeding, visual symptoms or suspected infection.

Mometasone (nasal)

drug class: Intranasal corticosteroid. uses: Allergic rhinitis and selected nasal inflammatory conditions. side effects: Nosebleeds, nasal irritation, dryness and headache. important cautions: Use correct spray technique and aim away from the septum. Benefit is not always immediate. Seek review for persistent bleeding or visual symptoms.

Fluticasone (nasal)

drug class: Intranasal corticosteroid. uses: Allergic rhinitis, including seasonal and perennial symptoms. side effects: Nosebleeds, nasal dryness, irritation and headache. important cautions: Regular correct use is important. Aim away from the septum and seek review for persistent bleeding. Check interactions and dose when using other corticosteroid products.

Montelukast

drug class: Leukotriene receptor antagonist (LTRA). uses: Add-on preventive treatment for asthma; selected patients with exercise-induced or allergic asthma symptoms. side effects: Headache and abdominal symptoms; neuropsychiatric reactions may occur. important cautions: Serious mood, behaviour and sleep changes, including suicidal thoughts, have been reported. Discuss these risks and seek prompt medical advice for new neuropsychiatric symptoms. Not a rescue medicine for acute asthma.