Bronchodilators

Bronchodilators are medications that relax the muscles in your airways to make it easier to breathe. Healthcare providers prescribe them to treat symptoms of asthma, COPD (chronic obstructive pulmonary disease) and other lung conditions.

They’re most often prescribed as inhalers and nebulizer solutions. Nebulized solutions use a machine to turn the liquid into a mist so it can better reach your lungs. Sometimes, you might take bronchodilators as a pill.

Bronchodilators (pronounced “bron-ko-DI-lay-ters”) can be short- or long- acting. Short-acting bronchodilators, like albuterol, can stop sudden asthma symptoms. They work quickly, but their effects only last a few hours.

Long-acting bronchodilators take longer (several weeks) to reach their full effect, but they work better over time. Healthcare providers prescribe them to manage asthma and COPD daily.

Before taking bronchodilators, let your provider know if you have any additional health conditions, especially glaucoma or conditions that can affect your bladder or prostate. This can help your provider recommend the best medications for your specific situation.

Bronchodilator medications

The most common types of bronchodilators include:

• Beta-2 agonists: These medications attach to receptors in your lungs — a bit like pushing a button — that cause your muscles to relax. These can be short-acting (SABAs), like albuterol and levalbuterol, or long-acting (LABAs), like salmeterol and formoterol.
• Anticholinergics: These medications, also called muscarinic antagonists, block receptors that acetylcholine attaches to. Acetylcholine is a chemical messenger that can tighten your airways. In other words, anticholinergics prevent acetylcholine from pushing a button that causes your symptoms. They can be short-acting (SAMAs), like ipratropium bromide, or long-acting (LAMAs), like tiotropium bromide.

Both types usually come in an inhaler (metered-dose, dry powder or mist). Sometimes, they come in a liquid you use in a nebulizer. LABAs are usually combined with a corticosteroid in one inhaler medication.

A third type of bronchodilator, theophylline, is rarely used anymore. It comes in a pill or liquid you swallow.

How do I use a bronchodilator?

Most bronchodilators come in an inhaler. Each device has its own instructions. Make sure you follow the directions for your specific device and ask your healthcare provider to show you how to use it. General directions include:

1. Open or take the cap off the inhaler.
2. For some dry powder inhalers, you may need to load a dose as directed. For metered-dose inhalers, you may need to prime your inhaler by shaking it and spraying it into the air as directed.
3. Take a deep breath in and breathe out as much air as you can.
4. Put the inhaler in your mouth.
5. With a dry powder inhaler, you breathe in quickly and deeply. Your breath pulls the medicine out of the inhaler. With a metered-dose inhaler, you’ll need to breathe in slowly through your mouth and press down on the canister. This timing is different depending on whether you’re using a spacer (a tube attached to the end of the mouthpiece).
6. Hold your breath for 10 seconds to allow the medicine to reach your lungs.
7. Repeat these steps for each puff your healthcare provider has recommended. Wait about one minute between each puff.
8. Rinse out your mouth and spit after using an inhaler that contains a corticosteroid to prevent thrush.

Side effects

The most common side effects of bronchodilators are nervousness, shakiness and increased heart rate. These are temporary and last for an hour or so after taking the medication.

The most serious side effect is paradoxical bronchospasm. This is when you have increased wheezing, coughing or shortness of breath after taking the medication. Call 911 or get help right away if your symptoms get worse after taking a bronchodilator.

Specific side effects by type of medication include:

• Beta-2 agonists: Nervous or shaky feelings, overexcitement, hyperactivity, increased heart rate, upset stomach and trouble sleeping
• Anticholinergic drugs: Bad or unusual taste in your mouth, nausea, vomiting, blurred vision, difficulty peeing, and dry throat, eyes and nose
• Theophylline: Nausea, vomiting, stomachache, diarrhea, headache, rapid or irregular heartbeat, muscle cramps and nervous or shaky feelings

How long does it take for bronchodilators to work?

Short-acting bronchodilators should give you symptom relief within a few minutes. If you’re not feeling better within 20 minutes of taking medication, call your doctor’s office or go to the nearest emergency room.

Long-acting bronchodilators can take several weeks to reach their full effect.

When should I call my healthcare provider?

When prescribing a bronchodilator, your provider will also give you an action plan. This gives you instructions for managing your breathing and tells you when to call your provider or seek emergency medical care. It’s personalized to you.

In general, if your bronchodilators aren’t managing your symptoms, or if you’re using a rescue inhaler more than twice per week, reach out to your healthcare provider.