List & Types of Bronchodilators: Side Effects & Uses

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What are bronchodilators, and how do they work?

Bronchodilators are medications that open (dilate) the airways (bronchial
tubes) of the lung by relaxing bronchial muscles and allow people who have
difficulty breathing to breath better. Bronchodilators are used for treating:

Asthma is a breathing problem resulting from narrowing of the airways that
allow air to move in and out of the lungs. These airways become narrowed from
the accumulation of mucus, spasm of the muscles that surround these airways
(bronchospasm), or swelling of the lining of the airways. Airway narrowing leads
to symptoms of asthma which include:

Do I need a prescription for bronchodilators?

  • Yes. Bronchodilators approved for treating asthma and other respiratory conditions
    are prescription products.
  • Over the counter (OTC), homeopathic, or herbal
    products often promoted for treating asthma are not approved by the FDA and they
    are not considered effective by many doctors.

What are the uses for bronchodilators?

The bronchodilators listed in this article are used for managing bronchospasm
due to asthma, reactive airway disease, and exercise-induced asthma.

  • Short-acting beta-adrenergic bronchodilators and ipratropium work quickly and
    are used for acute management of asthma episodes.
  • Long-acting beta-adrenergic
    bronchodilators, tiotropium, and theophylline are used daily and long-term for
    preventing asthma attacks or reducing the frequency of symptoms.

What types of bronchodilators are available to treat asthma?

The three types of bronchodilators used for treating asthma
are; 1) beta-adrenergic bronchodilators; 2) anticholinergic bronchodilators; and
3)

xanthine derivatives
.

  1. Beta-adrenergic bronchodilators dilate bronchial airways by relaxing the
    muscles that surround the airways. Beta-adrenergic bronchodilators are beta-2
    agonists. These medications stimulate beta-2 receptors on the smooth muscle
    cells that line the airways, causing these muscle cells to relax, thus, opening
    airways.
  2. Anticholinergic bronchodilators block the effect of acetylcholine on airways
    and nasal passages. Acetylcholine is a chemical that nerves use to communicate
    with muscle cells. In asthma, cholinergic nerves going to the lungs cause
    narrowing of the airways by stimulating muscles surrounding the airways to
    contract. The “anticholinergic” effect of anticholinergic bronchodilators blocks
    the effect of cholinergic nerves, causing the muscles to relax and airways to
    dilate.
  3. Xanthine derivatives open airways by relaxing the smooth muscles in the walls
    of the airways and they also suppress the response of the airways to stimuli.
    The mechanism of action of xanthines is not fully understood. Xanthine
    derivatives may dilate bronchi by blocking the action of phosphodiesterase (PDE)
    enzymes which ultimately leads to increased concentration of chemicals that
    dilate bronchial airways.



SLIDESHOW


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List of short-acting and long-acting bronchodilators, anticholinergic bronchodilators, and xanthine derivatives

Short-acting beta-adrenergic bronchodilator inhalers available in the US

  • albuterol (AccuNeb, Proair HFA, Proventil HFA, Ventolin HFA)
  • levalbuterol (Xopenex HFA)
  • epinephrine injection

Long-acting beta-adrenergic bronchodilator asthma inhalers available in the
US

  • salmeterol (Servant Diskus)
  • formoterol (Perforomist)

Anticholinergic bronchodilators available in the US

  • ipratropium (Atrovent HFA)
  • tiotropium (Spiriva Respimat)

Examples of xanthine derivatives available in the US

What are the side effects of bronchodilators?

Side effects of bronchodilators vary depending on the type of bronchodilator.

Beta-adrenergic bronchodilators side effects

Common side effects of beta-adrenergic bronchodilators include:

Other side effects of beta-adrenergic bronchodilators include:

Possible serious side effects of beta-adrenergic bronchodilators include:

Anticholinergic bronchodilators side effects

Common side effects of anticholinergic bronchodilators include:

Other side effects of anticholinergic bronchodilators include:

Possible serious side effects of anticholinergic bronchodilators include:

  • Life-threatening bronchospasms
  • Serious allergic reactions involving the closure of the airways.
  • Worsening symptoms of benign prostatic hyperplasia
  • Worsening symptoms of narrow-angle glaucoma

Xanthines side effects

Common side effects of xanthines include:

Other side effects of xanthines include:

Possible serious side effects of xanthines include:



QUESTION


Asthma is a chronic respiratory disease.
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Which drugs or supplements interact with bronchodilators?

Drug interactions of beta-adrenergic bronchodilators

  • Tricyclic antidepressants, for example, amitriptyline (Elavil, Endep), and
    monoamine oxidase inhibitors (MAOIs), for example, tranylcypromine, should not
    be combined with beta-adrenergic bronchodilators because of their additive
    effects on the vascular system (for example, increased blood pressure and/or
    heart rate). A period of two weeks should elapse between treatment with
    beta-adrenergic bronchodilators and tricyclic antidepressants or monoamine
    oxidase inhibitors.
  • Use of beta-adrenergic bronchodilators with other stimulant medications is
    discouraged because of their combined effects on heart rate, blood pressure, and
    the potential for causing chest pain in patients with underlying coronary heart
    disease.
  • Beta-blockers, for example, propranolol (Inderal, Inderal LA), block the
    effect of beta-adrenergic bronchodilators and may induce bronchospasm in
    asthmatics.
  • Beta-adrenergic bronchodilators may cause hypokalemia (low potassium).
    Therefore, combining beta-adrenergic bronchodilators with loop diuretics, for
    example, furosemide (Lasix), may increase the likelihood of hypokalemia.

Drug interactions of anticholinergic bronchodilators

  • Use with other anticholinergic drugs (for example, atropine) may increase the
    occurrence of side effects.

Drug interactions of xanthine bronchodilators

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Are bronchodilators safe to use during pregnancy or while breastfeeding?

Beta-adrenergic bronchodilators

  • Beta-adrenergic bronchodilators are used for treating children. However,
    there are no adequate studies of beta-adrenergic bronchodilator use during
    pregnancy. Some reports indicate that albuterol sulfate may cause congenital
    defects when used during pregnancy.
  • It’s not known whether beta-adrenergic bronchodilators are excreted in breast
    milk.

Anticholinergics

  • The safety of anticholinergic bronchodilators in pregnant women or nursing
    mothers has not been adequately evaluated.

Xanthine bronchodilators

  • Xanthine bronchodilators have not been adequately studied in pregnant women.
    Theophylline is excreted in breast milk and may cause mild side effects such as
    irritability in the infant.
  • The risks to the fetus or breast-feeding infant versus the risk to the woman should be considered before using bronchodilators in pregnant women; consultation with the patient’s OB/GYN doctor may be advisable.

Are there differences between bronchodilators?

Bronchodilators differ in their mechanism of action, how quickly they work,
and their duration of action, their uses, side effects, and how they are
administered. Beta-adrenergic bronchodilators are supplied as aerosols for
inhalation, powders for inhalation, solution for nebulization, syrup, and
tablets. Anticholinergic bronchodilators are supplied as solutions for
inhalation, powder for inhalation, and nebulized solution. Xanthines are
supplied as tablets, capsules, elixir, and solution for injection.

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Medically Reviewed on 10/28/2019

References

Barnes PJ. “Theophylline for COPD.” Thorax. 2006;61(9):742-744.

FDA Prescribing Information.





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