Bricanyl

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Bricanyl on Prescriptsy

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Bricanyl contains terbutaline sulphate, a selective short-acting beta-2 adrenoceptor agonist (SABA) used for the relief and prevention of bronchospasm in asthma, chronic obstructive pulmonary disease (COPD), and other conditions causing reversible airway obstruction.

Manufactured by AstraZeneca, the Bricanyl Turbohaler is a breath-actuated dry powder inhaler that delivers 500 micrograms of terbutaline per inhalation directly to the lungs, providing rapid relief of breathlessness, wheezing, and chest tightness within minutes.

Short-acting bronchodilators are an essential component of asthma and COPD management, providing on-demand symptom relief when airway narrowing occurs.

This page provides a comprehensive clinical overview of Bricanyl, covering its mechanism of action, correct inhaler technique, dosing for adults and children, side effects, safety warnings, and how to obtain a prescription in the UK.

All information follows current guidance from the British National Formulary (BNF), BTS/SIGN, NICE, and the MHRA.

Important safety information about Bricanyl

Before using Bricanyl, note the following key safety points. Bricanyl is a prescription-only medicine (POM) in the UK.

• Bricanyl is a reliever inhaler, not a preventer. It does not treat the underlying airway inflammation in asthma. Most people with asthma also need a daily preventer inhaler (inhaled corticosteroid).
• If you need to use your reliever more than three times per week, or if you are using more than one inhaler per month, your asthma may be poorly controlled. Seek an urgent medical review.
• Overuse of short-acting beta-2 agonists without adequate preventer therapy is associated with an increased risk of asthma attacks and asthma-related death.
• Keep your Bricanyl Turbohaler with you at all times for use in an emergency.

What is asthma

Asthma is a chronic inflammatory disease of the airways affecting approximately 5.4 million people in the UK, including 1.1 million children.

It is characterised by variable airflow obstruction, bronchial hyperresponsiveness, and chronic airway inflammation.

Triggers including allergens, exercise, cold air, respiratory infections, and air pollution cause bronchoconstriction (narrowing of the airways), mucosal oedema, and mucus hypersecretion, producing the characteristic symptoms of wheezing, breathlessness, chest tightness, and cough.

The goals of asthma treatment are to achieve and maintain symptom control, prevent exacerbations (asthma attacks), maintain normal lung function, minimise medication side effects, and prevent asthma-related mortality.

Treatment follows a stepwise approach as outlined in NICE NG80 and BTS/SIGN Guideline 158, with a SABA reliever as the foundation and inhaled corticosteroid (ICS) preventer therapy introduced at step 1 for most patients with recurrent symptoms.

What is COPD

Chronic obstructive pulmonary disease (COPD) is a progressive lung condition characterised by persistent airflow limitation that is not fully reversible.

It encompasses chronic bronchitis and emphysema and is predominantly caused by cigarette smoking.

COPD affects an estimated 1.2 million diagnosed individuals in the UK, with a significant number of undiagnosed cases. Symptoms include chronic breathlessness, cough, and sputum production.

Short-acting bronchodilators, including terbutaline, are used for as-needed symptom relief and as part of the acute management of COPD exacerbations.

How Bricanyl works

Terbutaline sulphate is a selective beta-2 adrenoceptor agonist. It works by stimulating beta-2 receptors on bronchial smooth muscle cells.

This activates the enzyme adenylate cyclase, increasing intracellular concentrations of cyclic adenosine monophosphate (cAMP).

Elevated cAMP activates protein kinase A, which phosphorylates key regulatory proteins, inhibiting calcium release and reducing the contractile activity of smooth muscle.

The net effect is relaxation of bronchial smooth muscle and opening of the airways.

In addition to direct bronchodilation, beta-2 agonists stabilise mast cell membranes, reducing the release of bronchoconstrictor mediators including histamine and leukotrienes. They also increase mucociliary clearance, helping to mobilise mucus from the lower airways.

Inhaled terbutaline has an onset of action within 3 to 5 minutes, with peak bronchodilator effect at 30 to 60 minutes.

The duration of action is approximately 4 to 6 hours. This rapid onset makes it ideal as a rescue medication for acute symptoms and for pre-exercise prophylaxis.

The Bricanyl Turbohaler

The Turbohaler is a multi-dose, breath-actuated dry powder inhaler (DPI) that does not contain a propellant.

It delivers terbutaline as a fine dry powder directly to the lungs when the patient inhales.

Because it is breath-actuated, there is no need to coordinate pressing a canister and breathing in simultaneously, which is a common difficulty with pressurised metered-dose inhalers (pMDIs).

The Turbohaler requires a moderate to high inspiratory flow rate (at least 30 litres per minute) to deaggregate and entrain the powder.

This means it is suitable for most adults and children over 5 years, but not for patients in severe respiratory distress or very young children who cannot generate sufficient inspiratory effort.

In acute severe asthma, a pMDI with spacer or nebulised bronchodilator should be used instead.

The device contains a dose indicator with a red mark that appears in the window when approximately 20 doses remain. When the mark reaches the bottom of the window, the inhaler is empty and should be replaced.

Clinical evidence and guidelines

BTS/SIGN Guideline 158 (British guideline on the management of asthma) and NICE NG80 (Asthma: diagnosis, monitoring and chronic asthma management) recommend an inhaled SABA as the first-line reliever for all patients with asthma.

Terbutaline and salbutamol are the two SABAs available in the UK; they are clinically equivalent in bronchodilator efficacy and safety profile.

The choice between them often depends on patient preference and inhaler device suitability.

For COPD, NICE NG115 recommends a short-acting bronchodilator (SABA or SAMA) as initial therapy for breathlessness and exercise limitation. In patients with persistent symptoms, long-acting bronchodilators (LABA or LAMA) are added, with the SABA retained for as-needed use.

Evidence from the SABINA III study and other pharmacoepidemiological analyses has highlighted the risks of SABA overuse without adequate preventer therapy in asthma.

The National Review of Asthma Deaths (NRAD) found that over-reliance on SABA relievers and under-use of ICS preventers were contributory factors in asthma deaths.

Current guidance emphasises that any patient using a SABA more than three times per week should have their preventer therapy reviewed and stepped up as appropriate.

How to use the Bricanyl Turbohaler

Correct inhaler technique is essential for effective drug delivery. Studies consistently show that a significant proportion of patients use dry powder inhalers incorrectly, reducing the amount of drug reaching the lungs. Follow these steps carefully.

Unscrew and remove the protective cover. Hold the Turbohaler upright with the grip at the bottom.

Twist the coloured grip fully in one direction and then twist it back until you hear a distinct click. This loads one dose. Do not shake the Turbohaler.

Breathe out gently, away from the mouthpiece (never breathe out into the device, as moisture can clog the powder mechanism).

Place the mouthpiece between your lips, forming a tight seal, and breathe in as deeply and forcefully as you can through your mouth.

Remove the inhaler from your mouth. Hold your breath for 5 to 10 seconds to allow the medication to settle in the lungs.

Breathe out slowly through your nose. Replace the cover after use.

If a second dose is needed, repeat the loading and inhalation steps. Ask your GP, asthma nurse, or pharmacist to check your technique at each review.

The Turbohaler delivers little or no taste when the dose is inhaled correctly, so the absence of a taste sensation does not mean the dose has not been delivered.

Side effects of Bricanyl

Common side effects

The most frequently reported adverse effects are fine hand tremor, palpitations, increased heart rate (tachycardia), and headache.

These are pharmacological consequences of beta-2 agonism and are usually mild, dose-related, and diminish with continued use. Muscle cramps, particularly in the legs, may occur.

Nervousness and restlessness have been reported, especially in children.

Uncommon and rare side effects

Uncommon effects include cardiac arrhythmias, hypokalaemia (which may be clinically significant in patients also taking corticosteroids, theophylline, or diuretics), and transient hyperglycaemia.

Paradoxical bronchospasm (immediate worsening of airways after inhalation) is rare but potentially serious; if it occurs, stop using the inhaler and seek medical attention.

Mouth and throat irritation, cough, and dryness can occur with the dry powder formulation. Sleep disturbances have been reported, particularly in children.

When to seek medical advice

Contact your GP, asthma nurse, or NHS 111 if you experience persistent or worsening palpitations, chest pain, a rapid or irregular heartbeat, increasing breathlessness despite treatment, or severe muscle cramps.

Call 999 in an asthma emergency: if you cannot complete a sentence in one breath, your reliever is not helping, your lips or fingernails appear blue, or you feel your life is at risk.

Report any suspected adverse reactions via the MHRA Yellow Card scheme at yellowcard.mhra.gov.uk .

Warnings and precautions

SABA overuse

Bricanyl is a reliever, not a preventer.

Using a SABA as the sole asthma treatment without an inhaled corticosteroid preventer is associated with an increased risk of severe exacerbations and death.

Current guidelines recommend that all patients with asthma who require a reliever more than occasionally should be prescribed a daily preventer inhaler.

If you are using your Bricanyl more than three times per week, or if you are ordering more than one reliever inhaler per month, contact your GP urgently for a treatment review.

Cardiovascular caution

Use terbutaline with caution if you have ischaemic heart disease, cardiac arrhythmias, hypertrophic cardiomyopathy, hypertension, or thyrotoxicosis. Beta-2 agonists can increase heart rate and may provoke arrhythmias in susceptible individuals.

Hypokalaemia

Beta-2 agonists can lower serum potassium levels. The risk is increased by concomitant treatment with corticosteroids (oral or high-dose inhaled), theophylline, diuretics, and hypoxia. Potassium levels should be monitored in patients at risk, particularly during severe asthma exacerbations.

Diabetes

Terbutaline may cause transient rises in blood glucose. Patients with diabetes should be aware of this effect and may need to monitor blood glucose more closely during periods of increased use.

Pregnancy and breastfeeding

Uncontrolled asthma poses a greater risk to mother and baby than the use of reliever medication.

Inhaled beta-2 agonists, including terbutaline, are generally considered safe in pregnancy and should be continued as needed.

Terbutaline is excreted in breast milk in small amounts; breastfeeding is generally acceptable at inhaled therapeutic doses. Consult your prescriber for personalised advice.

How to get a Bricanyl prescription in the UK

Bricanyl Turbohaler is a prescription-only medicine (POM) in the UK.

Your GP or asthma nurse will assess your symptoms, review your inhaler technique, check your asthma or COPD action plan, and confirm that a reliever inhaler is appropriate.

New patients with suspected asthma should undergo diagnostic assessment as recommended by NICE NG80 before starting treatment.

Authorised online prescribers registered with the GPhC may prescribe Bricanyl following a structured consultation, provided that the diagnosis is confirmed and the patient's treatment plan is documented.

All UK prescriptions are dispensed by registered pharmacies.

The standard NHS prescription charge in England is currently 9.90 pounds per item; prescriptions are free in Scotland, Wales, and Northern Ireland.

Living with asthma: self-management

Effective asthma self-management reduces the risk of exacerbations and improves quality of life.

NICE recommends that all patients with asthma should have a personalised asthma action plan (PAAP) agreed with their GP or asthma nurse.

This plan outlines daily preventer treatment, when and how to use the reliever, how to recognise worsening symptoms, and when to seek emergency help.

Attend annual asthma reviews with your GP practice to reassess control, check inhaler technique, review triggers, and update your action plan.

Avoid known triggers where possible, and get an annual flu vaccination as recommended by the NHS.

When to seek emergency help

Call 999 or go directly to A&E if you have a severe asthma attack that is not responding to your reliever inhaler, if you cannot speak in full sentences due to breathlessness, if your lips or fingernails turn blue (cyanosis), if you feel confused or exhausted from the effort of breathing, or if your peak flow reading is below 50% of your personal best.

While waiting for the ambulance, sit upright, stay calm, and continue to take one puff of your Bricanyl Turbohaler every minute, up to 10 puffs.

These steps can be life-saving.

Sources

• Bricanyl Turbohaler 500 micrograms, Summary of Product Characteristics (EMC)
• Terbutaline sulfate, British National Formulary (BNF)
• NICE NG80: Asthma, diagnosis, monitoring and chronic asthma management
• NICE NG115: Chronic obstructive pulmonary disease in over 16s
• BTS/SIGN Guideline 158: British guideline on the management of asthma
• Asthma, NHS
• MHRA Yellow Card Scheme