- Inhaled short-acting beta2-agonists should be used as required unless an individual has shown to benefit from regular use:
- As-required use of short-acting beta2-agonists is at least as effective as regular administration [SIGN and BTS, 2011] and is less likely to result in tolerance.
- Inhaled short-acting beta2-agonists have minimal adverse effects. Overuse can cause tremor, tension, headache, muscle cramps, and palpitations [BNF 53, 2007]. Hypokalaemia may result from high doses of inhaled beta2-agonists (or oral beta2-agonists); this may be potentiated by concomitant treatment with theophylline, corticosteroids, diuretics, and by hypoxia. The Committee on the Safety of Medicines has advised that plasma potassium should be monitored in people with severe asthma [CSM, 1990].
- There is some evidence from post-marketing data and published literature of myocardial ischaemia associated with short-acting beta2-agonists. The MHRA has issued advice that people with a history of heart disease, including angina or rhythm disturbance, should seek medical advice if symptoms such as shortness of breath or chest pain occur, as these may indicate worsening heart disease [MHRA, 2007].
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