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Patients should be instructed in the proper use of the inhaler and their technique checked, to ensure that aerosol actuation is synchronised with inspiration of breath for the optimum delivery of the active substance to the lungs. Patients should be warned that they may experience a different taste upon inhalation compared to their previous inhaler.
The management of asthma should normally follow a stepwise programme, and the patient's response should be monitored clinically and by lung function tests.
Patients who are prescribed regular anti-inflammatory therapy (e.g., inhaled corticosteroids) should be advised to continue taking their anti-inflammatory medication even when symptoms decrease, and they do not require Asthalin Inhaler.
Increasing use of short-acting bronchodilators, in particular β2-agonists to control symptoms, indicates deterioration of asthma control and patients should be warned to seek medical advice as soon as possible. Under these conditions, the patient's therapy plan should be reassessed. Patients with persistent asthma should receive optimal anti-inflammatory basic therapy with corticosteroids. Sudden and progressive deterioration in asthma control is potentially life threatening and consideration should be given to increasing or starting oral and/or inhaler corticosteroid therapy. In patients considered at risk, daily peak flow monitoring may be instituted.
Overuse of short-acting beta-agonists may mask the progression of the underlying disease and contribute to deteriorating asthma control, leading to an increased risk of severe asthma exacerbations and mortality.
Patients who take more than twice a week "as needed" salbutamol, not counting prophylactic use prior to exercise, should be re-evaluated (i.e., daytime symptoms, night-time awakening, and activity limitation due to asthma) for proper treatment adjustment as these patients are at risk for overuse of salbutamol.
The patient should be advised to seek medical advice if a previously effective dose ceases to be effective for at least three hours, and/or their asthma seems to be worsening.
The dosage or frequency of administration should only be increased on medical advice.
Patients requiring long-term management with salbutamol device should be kept under regular surveillance.
Salbutamol should be administered cautiously to patients with thyrotoxicosis, coronary insufficiency, hypertrophic obstructive cardiomyopathy, arterial hypertension, tachyarrhythmias, in concomitant use of cardiac glycosides or diabetes mellitus.
Potentially serious hypokalaemia has been reported in patients taking β2-agonist therapy mainly from parenteral and nebulised administration. Particular caution is advised in acute severe asthma as this effect may be potentiated by concomitant treatment with xanthine derivatives, steroids, diuretics, long-term laxatives and by hypoxia. Extra care should therefore be taken if β2-agonist are used in these groups of patients and it is recommended that serum potassium levels should be monitored in such situations.
Care should be taken when treating acute asthma attacks or exacerbation of severe asthma as increased serum lactate levels, and rarely, lactic acidosis have been reported after high doses of salbutamol have been used in emergency situations. This is reversible on reducing the dose of salbutamol (see Overdosage).
Unwanted stimulation of cardiac adrenoceptors can occur in patients taking β2-agonist therapy.
Cardiovascular effects may be seen with sympathomimetic drugs, including salbutamol. There is some evidence from post-marketing data and published literature of rare occurrences of myocardial ischaemia associated with β-agonists. Patients with underlying severe heart disease (e.g. ischaemic heart disease, arrhythmias or severe heart failure) who are receiving salbutamol should be warned to seek medical advice if they experience chest pain or other symptoms of worsening heart disease. Attention should be paid to assessment of symptoms such as dyspnoea and chest pain, as they may be either respiratory or cardiac in origin.
As with other inhalation therapy, the potential for paradoxical bronchospasm should be considered. If this occurs, the salbutamol should be discontinued immediately and an alternative presentation or a different fast acting inhaled bronchodilator given. Solutions which are not of neutral pH may rarely cause paradoxical bronchospam in some patients.
Salbutamol and non-selective β-antagonists such as propranolol should not usually be prescribed together.
In common with other β-agonists, salbutamol can induce reversible metabolic changes such as increased blood glucose levels. Patients with diabetes may be unable to compensate for the increase in blood glucose and the development of ketoacidosis has been reported. Concurrent administration of glucocorticoids can exaggerate this effect.
Severe exacerbations of asthma must be treated in the normal way.
Effects on ability to drive and use machines: Salbutamol may cause dizziness. If affected, do not drive or operate machinery.
