Bronchodilator

What is a bronchodilator?

A bronchodilator (pronounced “bron-ko-di-lay-ter”) is a type of medication that relieves the symptoms of asthma, chronic obstructive pulmonary disease (COPD) and other lung conditions. It quickly relaxes the muscle bands that tighten around your airways (bronchi). When those muscles relax, more air comes in and out of your lungs so you can breathe comfortably.

Bronchodilators also help clear mucus from your lungs. As your airways open, mucus moves more freely, which allows you to cough mucus out of your body easily.

Bronchodilators are primarily available as inhalers and nebulizer (a battery-powered machine that creates a fine spray) solutions.

What are the forms of bronchodilators?

There are two forms of bronchodilators:

• Short-acting bronchodilators. Short-acting bronchodilators quickly relieve or stop sudden (acute) asthma symptoms. They’re effective for three to six hours. Another name for a short-acting bronchodilator is a rescue inhaler. Inhalers are canisters of medicine in a plastic holder with a mouthpiece. When you spray an inhaler, it gives a consistent dose of medication.
• Long-acting bronchodilators. Long-acting bronchodilators keep your airways open for 12 hours. You use these inhalers every day to prevent asthma attacks.

What are the types of bronchodilators?

There are three main types of bronchodilators: beta 2-agonists, anticholinergics and theophylline.

Beta 2-agonists

Beta 2-agonists exist in short-acting forms and long-acting forms.

Short-acting beta 2-agonists (SABAs) quickly open your airways to stop asthma symptoms. People sometimes refer to SABAs as “reliever” or “rescue” medicines because they’re the best medications for treating sudden, severe or new asthma symptoms.

SABAs work within 15 to 20 minutes and last for four to six hours. You may also use them 15 to 20 minutes before exercising to prevent asthma symptoms that arise from physical activity.

In inhaled forms, SABA medications include:

• Albuterol (Ventolin®).
• Levalbuterol (Xopenex®).
• A combination of albuterol and ipratropium bromide (DuoNeb®).

You may take long-acting beta-2 agonists (LABAs) twice a day for long-term control and maintenance of your airways. You should also use LABAs with an inhaled corticosteroid to treat asthma. Corticosteroids help reduce swelling in your airways and lungs. LABAs are also effective in treating exercise-induced asthma.

LABAs are available as a dry powder inhaler (DPI). These medications include:

• Salmeterol (Serevent®).
• Formoterol (Foradil®).
• Combination medications, including fluticasone and salmeterol (Advair®), budesonide and formoterol (Symbicort®) and fluticasone and vilanterol (Breo®).

Anticholinergics

Anticholinergics are available as ipratropium bromide (Atrovent®) and tiotropium bromide (Spiriva Respimat®). They block the effects of acetylcholine. Acetylcholine is a neurotransmitter that your body makes.

Ipratropium bromide is available as an inhaler and a nebulizer solution. You can use it up to four times a day.

Tiotropium bromide is available as an inhaler. Depending on which kind your healthcare provider prescribes, you can use it once a day or four times a day.

Anticholinergics aren’t quick-relief medications. However, they’re effective in controlling difficult asthma symptoms.

Theophylline

Theophylline (Uniphyl®) is available as a pill that you take with water. You take it one time each day to help control severe asthma symptoms. However, theophylline is no longer a preferred treatment method.

When you take theophylline, you must take blood tests to ensure you’re receiving the proper amount of medicine.

What are the side effects of bronchodilators?

The side effects of bronchodilators vary according to which type you use.

Side effects of beta 2-agonists include:

• Nervous or shaky feelings.
• Overexcitement.
• Hyperactivity.
• Increased heart rate.
• Upset stomach.
• Trouble sleeping.

Some beta 2-agonists, including albuterol, are available as pills or syrups. You may have more side effects when you take these forms because they’re a higher dosage. You also absorb them through your bloodstream.

Side effects of anticholinergic drugs include:

• Dry throat, eyes and nose.
• Unusual taste.
• Nausea and vomiting.
• Temporary blurred vision if the medicine gets in your eyes.

Anticholinergic drugs may make it difficult to urinate (pee). Talk to your healthcare provider if you have any conditions that affect your bladder. These conditions may include benign prostate enlargement (BPE), bladder stones or prostate cancer.

Side effects of theophylline include:

• Nausea and vomiting.
• Stomach ache.
• Diarrhea.
• Headache.
• Rapid or irregular heartbeat.
• Muscle cramps.
• Nervous or shaky feelings.

Is a bronchodilator a steroid?

No, a bronchodilator isn’t a steroid.

You may use inhaled steroids daily to help prevent asthma and COPD symptoms. They help reduce airway inflammation.

How do I use a bronchodilator inhaler?

It’s important to use your bronchodilator inhaler properly to get the full medication dosage. The following steps will help you properly use your bronchodilator inhaler:

1. Shake your inhaler about 10 to 15 times. Make sure the cap is on tight.
2. Remove the cap.
3. Take a deep breath in and breathe out completely.
4. Put your mouth around the mouthpiece.
5. Press the inhaler down once.
6. Take a slow, deep breath in through your mouth. If you hear a horn-like sound, you’re breathing too quickly and must slow down.
7. Hold your breath for 10 seconds. Count slowly to allow the medication to reach your lungs’ airways.
8. Repeat these steps for each puff your healthcare provider has recommended. Wait about one minute between each puff.
9. Replace the cap on your inhaler when you’re finished.
10. If you’re using a corticosteroid inhaler, gargle water or mouthwash after you’re finished. Rinsing your mouth helps reduce any side effects.

Do bronchodilator inhalers damage my lungs?

Your body may fail to respond to the medicine if you use your bronchodilator too much. Overuse can also cause your body to become overly sensitive to asthma or COPD triggers. Triggers may include smoke, pollution, dust and chemical fumes.

Using steroid inhalers may also increase your risk of developing nontuberculous mycobacteria infections or pneumonia, especially if you’re 65 or older.

How long should I wait between inhaler uses?

If you’re using a rescue inhaler, wait about one minute between each recommended puff.

If you’re using a long-acting beta-2 agonist, use it twice a day. You may use it in the morning and six to eight hours later.

Take an anticholinergic around the same time every day.

When should I see my healthcare provider?

Talk to your healthcare provider if you have any symptoms that affect your lungs. Symptoms may include difficulty breathing, coughing or wheezing. They can order pulmonary function testing (lung functions tests). Lung function tests help diagnose a lung condition that a bronchodilator may treat.

It’s also a good idea to talk to your healthcare provider if you need to use SABAs more than twice per week. Using SABAs more than twice a week is a sign of unstable asthma. Your healthcare provider may wish to change the dose of any long-term control medicines that you take.

A note from Cleveland Clinic

Lung conditions such as asthma and chronic obstructive pulmonary disease affect your airways. Bronchodilators are medications that can help you control the symptoms of a lung condition.

Always follow your healthcare provider’s medication plan. If your bronchodilators aren’t controlling your symptoms, reach out to your healthcare provider right away. They can answer your questions, address any concerns and find the right care plan for you.