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Medical Author:

George Schiffman, MD, FCCP

George Schiffman, MD, FCCP

Dr. Schiffman received his B.S. degree with High Honors in biology from Hobart College in 1976. He then moved to Chicago where he studied biochemistry at the University of Illinois, Chicago Circle. He attended Rush Medical College where he received his M.D. degree in 1982 and was elected to the Alpha Omega Alpha Medical Honor Society. He completed his Internal Medicine internship and residency at the University of California, Irvine.

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Medical Editor:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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Albuterol (Ventolin, Proventil), formoterol (Foradil), levalbuterol (Xopenex), metaproterenol (Alupent, Metaprel), pirbuterol (Maxair), and salmeterol (Serevent) are used to decrease bronchospasm.

Some long-acting (>12 hours) beta-agonists (for example, formoterol and salmeterol) are specifically designed to prevent asthma attacks and not to treat acute attacks. Other beta-agonists have a quicker onset and may be used for prevention (along with corticosteroid inhalers) and as rescue therapy. Beta-agonists are also useful to use before exercise for exercise-induced asthma.

How beta-agonists work

These drugs relax muscles within the airway that cause bronchospasm. Beta-agonists also cause the airway passages to open wider, thus making breathing easier.

Who should not use these medications

Individuals who are allergic to beta-agonists should not take these drugs.

Use

Both handheld inhalers and a solution for use with a nebulizer are available. Many inhaled products have specific devices and you should be thoroughly informed on how to use the inhaler or nebulizer prescribed for you. Frequency of administration depends on the specific product.

Drug or food interactions

Inhaled anticholinergic medications, such as ipratropium (Atrovent), enhance beta-agonists' effectiveness.

Side effects

Beta-agonists may cause rapid heartbeat and tremor (shakiness). Individuals with heart disease, hyperthyroidism, seizure disorders, or hypertension should be closely monitored by their doctor.

Combination therapy

Commonly, long-acting beta-agonist therapy and inhaled corticosteroids are used together. These drugs work so that the effectiveness of each component can by enhanced when the other agent is given simultaneously. Combining these agents into a single delivery system also enhances compliance and simplifies care. The two current available brands of combination therapy are Advair (fluticasone and salmeterol), which uses a powder form of the medications, and Symbicort (budesonide and formoterol) in an inhaler device that includes a propellant. Both of these combination medications come in different strengths. The strength pertains only to the inhaled corticosteroid component. The long-acting beta-agonist dose does not change. Side effects are the same, as noted under the individual components discussed above.

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