Bronchodilator

Overview

A bronchodilator is a medication used to relieve symptoms of asthma, chronic obstructive pulmonary disease (COPD), and other lung conditions by quickly relaxing the muscle bands around the airways (bronchi). This relaxation allows more air to flow in and out of the lungs, facilitating easier breathing. Additionally, bronchodilators help clear mucus from the lungs by enabling it to move more freely, making it easier to cough out. These medications are primarily available as inhalers and nebulizer solutions, the latter being a battery-powered machine that creates a fine spray for inhalation.

There are two forms of a bronchodilator:

• Short-acting bronchodilators: Acute (sudden) asthma symptoms are promptly relieved or stopped with short-acting bronchodilators. For three to six hours, they work effectively. A rescue inhaler is another term for a short-acting bronchodilator. Medicine canisters with a mouthpiece enclosed in a plastic holder are called inhalers. An inhaler provides a steady dosage of medication when sprayed.
• Long-acting bronchodilators: Your airways remain open for 12 hours when using long-acting bronchodilators. You avoid asthma attacks by using these inhalers on a daily basis.

Types

Bronchodilators are essential medications used in the management of asthma. There are three main types of bronchodilators: beta 2-agonists, anticholinergics, and theophylline. Each type serves a unique purpose in the treatment of asthma.

Beta 2-agonists

Short-acting beta 2-agonists (SABAs):

• Purpose: Provide quick relief from asthma symptoms by rapidly opening airways.
• Usage: Often referred to as “reliever” or “rescue” medications, SABAs are the go-to treatment for sudden, severe, or new asthma symptoms.
• Effectiveness: Work within 15 to 20 minutes and last for four to six hours. They can also be used preventatively before exercise to avoid exercise-induced symptoms.
• Common SABAs:
  • Albuterol
  • Levalbuterol
  • Combination of albuterol and ipratropium bromide

Long-acting beta 2-agonists (LABAs):

• Purpose: Provide long-term control and maintenance of asthma symptoms.
• Usage: Taken twice daily, LABAs should always be used in conjunction with an inhaled corticosteroid to effectively manage asthma and reduce airway inflammation.
• Effectiveness: Particularly useful for preventing exercise-induced asthma.
• Common LABAs:
  • Salmeterol
  • Formoterol
• Combination medications:
  • Fluticasone and salmeterol
  • Budesonide and formoterol
  • Fluticasone and vilanterol

Anticholinergics

• Purpose: Anticholinergics help manage asthma by blocking the effects of acetylcholine, a neurotransmitter that can cause airway constriction.
• Common Anticholinergics:
  • Ipratropium bromide: Available as an inhaler or nebulizer solution, it can be used up to four times a day.
  • Tiotropium bromide: Available as an inhaler, with usage varying from once to four times daily based on the healthcare provider’s prescription.
• Effectiveness: While not suitable for quick relief, anticholinergics are effective for controlling persistent and challenging asthma symptoms.

Theophylline

• Purpose: Theophylline is used to control severe asthma symptoms.
• Usage: Taken as a pill with water, usually once daily.
• Considerations: Theophylline requires regular blood tests to ensure proper dosing. Despite its effectiveness, it is no longer a preferred treatment method due to its need for careful monitoring and potential side effects.

Risk

Overuse of bronchodilators can lead to reduced effectiveness of the medication and increased sensitivity to asthma or COPD triggers such as smoke, pollution, dust, and chemical fumes. Additionally, the use of steroid inhalers may elevate the risk of developing nontuberculous mycobacteria infections or pneumonia, particularly in individuals aged 65 or older.

Side effects of bronchodilators

Beta 2-agonists:

• Common side effects: Nervousness, shakiness, overexcitement, hyperactivity, increased heart rate, upset stomach, and trouble sleeping.
• Forms: Pills or syrups, such as albuterol, may cause more side effects due to higher dosages and absorption through the bloodstream.

Anticholinergic drugs:

• Common side effects: Dry throat, eyes, and nose; unusual taste; nausea and vomiting; temporary blurred vision if in contact with eyes.
• Additional concern: Difficulty urinating, especially for those with bladder-related conditions like benign prostate enlargement, bladder stones, or prostate cancer. Consult your healthcare provider if affected.

Theophylline:

• Common side effects: Nausea, vomiting, stomach ache, diarrhea, headache, rapid or irregular heartbeat, muscle cramps, and nervousness.

Procedure

Using your bronchodilator inhaler properly ensures you receive the full medication dosage. Follow these steps to use your bronchodilator inhaler correctly:

First, shake your inhaler 10 to 15 times with the cap on tight. Next, remove the cap from the mouthpiece. Then, take a deep breath in and breathe out completely. Place your mouth around the mouthpiece and press the inhaler down once while taking a slow, deep breath in through your mouth. If you hear a horn-like sound, you’re breathing too quickly and need to slow down.

Hold your breath for 10 seconds, counting slowly to allow the medication to reach your lungs’ airways. Repeat these steps for each puff your healthcare provider has recommended, waiting about one minute between each puff.

Once you’re finished, replace the cap on your inhaler. If you’re using a corticosteroid inhaler, gargle water or mouthwash to reduce any side effects.

Outcome

Always adhere to your healthcare provider’s prescribed medication regimen. Should your symptoms persist despite bronchodilator use, promptly consult your healthcare provider. They can devise an optimal treatment plan, address any concerns you may have, and provide answers to your inquiries.
Should you encounter any respiratory issues such as breathing difficulties, coughing, or wheezing, seek guidance from your healthcare provider. Lung function tests can be conducted to assess your condition and determine if bronchodilator therapy is appropriate.

If you find yourself needing short-acting beta-agonists (SABAs) more than twice a week, it’s advisable to discuss this with your healthcare provider. Frequent SABA use exceedingly twice weekly may indicate unstable asthma. Your healthcare provider may consider adjusting the dosage of any long-term control medications accordingly.