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Diseases & Conditions

Treating Asthma with Bronchodilators

Bronchodilators relieve asthma symptoms by relaxing the muscle bands that tighten around the airways. This action rapidly opens the airways, letting more air come in and out of the lungs. As a result, breathing improves. Bronchodilators also help clear mucus from the lungs. As the airways open, the mucus moves more freely and can be coughed out more easily.

In short-acting forms, bronchodilators relieve or stop asthma symptoms and are very helpful during an asthma attack. In long-acting forms, bronchodilators help control asthma symptoms and prevent asthma attacks.

There are two main types of bronchodilator medications: beta 2-agonists (short- and long-acting forms) and anticholinergics.

Beta 2-agonists - Short-acting inhaled forms include:

  • Albuterol (Proventil HFA, Ventolin HFA, Accuneb)
  • Alupent
  • Combivent (combines a beta 2-agonist and an anticholinergic, see below)
  • Duoneb (combines a beta 2-agonist and an anticholinergic, see below)
  • Maxair
  • Tornalate
  • Ventolin
  • Xoponex

Short-acting beta 2-agonists are also called "quick acting" or "rescue" medications because they relieve asthma symptoms very quickly by opening the airways. These inhalers are the best for treating sudden and severe or new asthma symptoms. They work within 20 minutes and last 4-6 hours. They are also the medications to use 15-20 minutes before exercise to prevent exercise-induced asthma symptoms. Albuterol (Proventil HFA, Ventolin HFA, Accuneb) is available in oral form as pills or liquid.

Overuse of short-acting beta 2-agonists is a sign of unstable asthma. If you need to use your short-acting beta 2-agonists more than twice per week, talk to your doctor about increasing the amounts of long-term control medications you take, such as inhaled steroids and long-acting beta 2-agonists (see below).

Beta 2-agonists - Long-acting forms include:

  • Advair (combines a beta 2-agonist and anti-inflammatory drug)
  • Serevent
  • Foradil

Note: The long-acting forms of beta 2-agonists are use to provide control -- NOT QUICK RELIEF -- of asthma. These drugs take longer to begin to work, but their benefits last longer, even up to 12 hours.

Serevent and Foradil are the only inhaled, long-acting beta 2-agonists available. They are used twice a day to maintain open airways for long term-control. They have also been shown to be helpful in treating exercise-induced asthma. Serevent and Foradil are available in dry powder inhaler (DPI) form. Serevent is also available in Advair as a combination medication along with an inhaled corticosteroid.

Side effects of beta 2-agonists include:

  • nervous or shaky feeling
  • overexcitement or hyperactivity
  • increased heart rate
  • upset stomach (rare)
  • trouble sleeping (rare)

Oral forms of beta 2-agonists (pills or syrups) tend to have more side effects because they are in higher doses and are absorbed throughout the bloodstream to get to the lungs. Inhaled forms are deposited directly in the lungs and therefore have fewer side effects.

Anticholinergic drugs

Atrovent is another type of bronchodilator called an anticholinergic drug. It is available in both a metered dose inhaler and nebulizer solution. For asthma, it works best when used with a short-acting beta 2-agonist inhaler. It is not a quick relief medication because it takes about 60 minutes before it begins to work. It isn't commonly used to treat asthma.

Atrovent is another type of bronchodilator called an anticholinergic drug. It is available in both a metered dose inhaler and nebulizer solution. For asthma, it works best when used with a short-acting beta 2-agonist inhaler. It is not a quick relief medication because it takes about 60 minutes before it begins to work. It isn't commonly used to treat asthma.

Side effects are minor; dry throat is the most common. If the medication gets in the eyes, it may cause blurred vision for a short period of time.

Theophylline

Theophylline is another type of bronchodilator that is used to control asthma. It is sold under the brand names Uniphyl, Theo-Dur, Slo-Bid, and Theo-24, and is available as a pill or as an intravenous (through the vein) drug. It is long-acting and prevents asthma attacks. Theophylline is used to treat difficult-to-control or severe asthma and must be taken daily

Side effects include:

  • nausea and/or vomiting
  • diarrhea
  • stomach ache
  • headache
  • rapid or irregular heartbeat
  • muscle cramps
  • jittery or nervous feeling
  • hyperactivity

These symptoms may be a sign of too much medication. Your doctor will check your blood levels to make sure you're receiving the proper amount.

Always tell your doctors if you take theophylline for asthma because certain medications, such as antibiotics containing erythromycin or seizure and ulcer medicine, can interfere with the way theophylline works. And, viral illnesses can change how your body responds to theophylline.

Also, keep in mind that cigarette smoke can interfere with how your body responds to theophylline. Therefore, it is best to avoid smoke when possible.