Bronchodilator
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
A bronchodilator is a substance that dilates the bronchi and bronchioles, increasing airflow. Bronchodilators may be endogenous (originating naturally within the body), or they may be medications administered for the treatment of breathing difficulties. Bronchial asthma is the most common application of these drugs. They are also intended to help improve the breathing capacity of patients with emphysema, pneumonia and bronchitis.
Pharmaceutically bronchodilators belong to β2 mimetics - they act on β2 receptors in bronchial smooth muscle and bronchial mucous membranes. Bronchodilators, particularly non-prescription ones, are often misused as stimulants. A common side effect of these medications is desensitization, which may produce refractory bronchospasm.
Bronchodilators are either short-acting or long-acting. Short-acting medications provide quick or "rescue" relief from acute bronchoconstriction. Long-acting bronchodilators help to control and prevent symptoms. The three types of prescription bronchodilating drugs are β2-agonists (short- and long-acting), anticholinergics (short-acting), and theophylline (long-acting).
Short-acting β2-agonists
These are quick-relief or "rescue" medications that provide fast, temporary relief from asthma symptoms or flare-ups. These medications usually take effect within 20 minutes or less, and can last from four to six hours. These inhaled medications are best for treating sudden and severe or new asthma symptoms. Taken 15 to 20 minutes ahead of time, these medications can also prevent asthma symptoms triggered by exercise or exposure to cold air. Patients who regularly or frequently need to take short-acting β2-agonists should consult their doctor, as such usage indicates uncontrolled asthma, and their routine medications may need adjustment.
Long-acting β2-agonists
These are long-term medications taken routinely in order to control and prevent bronchoconstriction. They are not intended for fast relief. These medications take longer to begin working, but relieve airway constriction for up to 12 hours.
- Inhaled - Commonly taken twice a day with an anti-inflammatory medication, they maintain open airways and prevent asthma symptoms, particularly at night.
- Oral - Long-acting albuterol is available in pill or syrup form.
Effective for 12 hours, albuterol is particularly helpful for nighttime asthma symptoms. Because this medication requires high dosing, there tend to be increased side effects. Therefore it is not commonly prescribed. Side effects include increased heart rate, hyperactivity, feeling nervous, shaky, or over-excited, and very rarely, upset stomach or difficulty sleeping.
Anticholinergics
Only available as an inhalant, ipratropium bromide relieves acute or new asthma symptoms. Because it has no effect on asthma symptoms when used alone, it is most often paired with a short-acting β2-agonist.While it is considered a relief or rescue medication, it can take a full hour to begin working. For this reason it plays a minor role in asthma treatment. Dry throat is the most common side effect. If the medication gets in contact with the eyes, it may cause blurred vision for a brief time.
Theophylline
Available in oral and injectable form, theophylline is a long-acting bronchodilator that prevents asthma episodes. It belongs to the chemical class, methyl xanthines (along with caffeine). It is prescribed in severe cases of asthma or those that are difficult to control. It must be taken 1-4 times daily and doses cannot be missed. Blood tests are required to monitor therapy and to indicate when dosage adjustment is necessary. Side effects can include nausea, vomiting, diarrhea, stomach or headache, rapid or irregular heart beat, muscle cramps, nervous or jittery feelings, and hyperactivity. These symptoms may signal the need for an adjustment in your medication. It may promote acid reflux, also known as GERD, by relaxing the lower esophageal sphincter muscle. Some medications, such as seizure and ulcer medications and antibiotics containing erythromycin, can interfere with the way theopylline works. Coffee, tea, colas, cigarette smoking, and viral illnesses can all affect the action of theophylline and change its effectiveness. A physician should monitor dosage levels to meet each patient's profile and needs.
Brand names of common bronchodilators
Following the standard convention of medicine, the capitalized brand name is followed by the lowercased generic name in parentheses.
- Accu-Hale
- Maxair (pirbuterol)
- Primatene (epinephrine)
- Proventil (salbutamol = albuterol)
- Serevent (salmeterol)
- Ventolin (salbutamol = albuterol)
- Xopenex (levalbuterol)