- What are bronchodilators, and how do they work?
- Do I need a prescription for bronchodilators?
- What are the uses for bronchodilators?
- What types of bronchodilators are available to treat asthma?
- List of short-acting and long-acting bronchodilators, anticholinergic bronchodilators, and xanthine derivatives
- What are the side effects of bronchodilators?
- Which drugs or supplements interact with bronchodilators?
- Are bronchodilators safe to use during pregnancy or while breastfeeding?
- Are there differences between bronchodilators?
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:
- Chronic obstructive pulmonary disease (COPD
- Allergic reactions
- Related conditions that cause breathing problems
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.
Quick GuideAsthma Symptoms, Causes, and Medications
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?
- 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.
- 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.
- 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.
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
- theophylline (Theo 24, Elixophyllin, Uniphyl)
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:
- Migraine headaches
- Non-migraine headaches
- Stomach upset
- Flu-like symptoms
- Cold symptoms
- Ear infections (otitis media)
Other side effects of beta-adrenergic bronchodilators include:
- Allergic reactions (rash, hives, itching)
- Increased sputum
- Shortness of breath
Possible serious side effects of beta-adrenergic bronchodilators include:
- Bronchospasm (worsening of asthma)
- Serious allergic reactions (anaphylaxis)
- Low potassium
- Abnormal heart rhythm (palpitations)
- Fast heart rate
- Elevated blood pressure
- Chest pain
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:
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
- Allopurinol (Zyloprim), cimetidine (Tagamet), ciprofloxacin (Cipro), clarithromycin (Biaxin), itraconazole (Sporanox), ketoconazole, erythromycin, oral contraceptives, fluvoxamine (Luvox), ephedrine, and propranolol (Inderal) elevate theophylline blood levels and can lead to toxicity. Theophylline toxicity causes nausea, vomiting, insomnia, seizures, agitation, and life- threatening heart rhythm abnormalities.
- St. John's Wort, rifampin, and carbamazepine decrease levels of theophylline and potentially its effect by increasing its elimination.
- Theophylline may decrease levels and the effect of carbamazepine by increasing its elimination. Theophylline is metabolized mainly by the liver and dosages should be reduced in patients with liver dysfunction. On the other hand, theophylline is generally metabolized more rapidly in smokers (both tobacco and marijuana) and higher dosages may be required.
Are bronchodilators safe to use during pregnancy or while breastfeeding?
- 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.
- The safety of anticholinergic bronchodilators in pregnant women or nursing mothers has not been adequately evaluated.
- 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.
Bronchodilators are prescription medications used to treat
Side effects depend upon the type of bronchodilator used
- long-acting beta-adrenergic,
- short-acting beta-adrenergic,
- anticholinergic, or
- xanthine derivatives.
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Treatment & Diagnosis
Medications & Supplements
- ipratropium bromide inhaler, Atrovent, Atrovent HFA
- albuterol (Accuneb, Ventolin & Proventil [all discontinued])
- xanthine derivatives-oral
- salmeterol, Serevent
- albuterol and ipratropium inhaler, Combivent, Combivent Respimat
- albuterol pediatric pre-mixed solution - inhalation, AccuNeb
- ipratropium solution - inhalation, Atrovent
- theophylline, Elixophyllin, Theo-24, (Theolair, Uniphyl Theo-Dur, and Slo-Phyllin-discontinued)
- Advair Diskus, Advair HFA (fluticasone and salmeterol oral inhaler)
- levalbuterol pre-mixed solution - inhalation, Xopenex
- guaifenesin/theophylline/pseudoephedrine elixir - oral, Broncomar-1
Asthma and Allergy Resources
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
Barnes PJ. "Theophylline for COPD." Thorax. 2006;61(9):742-744.
FDA Prescribing Information.
Top Bronchodilators for Asthma Related Articles
Know Your Allergy TriggersAllergies are an overreaction of the immune system where the body's defenses react to substances such as pollen, food and more. Learn about common allergy triggers and how you can avoid an allergy attack.
AllergyAn allergy refers to a misguided reaction by our immune system in response to bodily contact with certain foreign substances. When these allergens come in contact with the body, it causes the immune system to develop an allergic reaction in people who are allergic to it. It is estimated that 50 million North Americans are affected by allergic conditions. The parts of the body that are prone to react to allergies include the eyes, nose, lungs, skin, and stomach. Common allergic disorders include hay fever, asthma, allergic eyes, allergic eczema, hives, and allergic shock.
Asthma OverviewAsthma is a condition in which hyperreactive airways constrict and result in symptoms like wheezing, coughing, and shortness of breath. Causes of asthma include genetics, environmental factors, personal history of allergies, and other factors. Asthma is diagnosed by a physician based on a patient's family history and results from lung function tests and other exams. Inhaled corticosteroids (ICS) and long-acting bronchodilators (LABAs) are used in the treatment of asthma. Generally, the prognosis for a patient with asthma is good. Exposure to allergens found on farms may protect against asthma symptoms.
Take the Asthma QuizAsthma is a chronic disease of the airways of the lungs, which can be managed with proper treatment. Triggered by two main causes, asthma symptoms can be brought on by environmental factors and surprising allergens.
Asthma: Over The Counter TreatmentPatients who have infrequent, mild bouts of asthma attacks may use over-the-counter (OTC) medications to treat their asthma symptoms. OTC asthma medicines are limited to epinephrine and ephedrine. These OTC drugs are best used with the guidance of a physician, as there may be side effects and the drugs may not be very effective.
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Bronchitis QuizWhat happens within the body when a person develops bronchitis? Take this quick quiz to learn the causes, symptoms, treatments, and complications of this common respiratory illness.
Chronic bronchitis is a cough that occurs daily with production of sputum that lasts for at least three months, two years in a row. Causes of chronic bronchitis include cigarette smoking, inhaled irritants, and underlying disease processes (such as asthma, or congestive heart failure). Symptoms include cough, shortness of breath, and wheezing. Treatments include bronchodilators and steroids. Complications of chronic bronchitis include COPD and emphysema.
Chronic cough is a cough that does not go away and is generally a symptom of another disorder such as asthma, allergic rhinitis, sinus infection, cigarette smoking, GERD, postnasal drip, bronchitis, pneumonia, medications, and less frequently tumors or other lung disease.
Chronic cough treatment is based on the cause, but may be soothed natural and home remedies.
COPD (Chronic Obstructive Pulmonary Disease)COPD or chronic obstructive pulmonary disease is a lung condition caused by smoking tobacco, exposure to secondhand smoke, and/or air pollutants. Conditions that accompany COPD include chronic bronchitis, chronic cough, and emphysema. Symptoms of COPD include shortness of breath, wheezing, and chronic cough. Treatment of COPD include GOLD guidelines, smoking cessation, medications, and surgery. The life expectancy of a person with COPD depends on the stage of the disease.
Take the COPD QuizCOPD is a combination of three conditions? Take this quiz to learn the three conditions that make up the pulmonary disease called chronic obstructive pulmonary disease (COPD).
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COPD vs. Emphysema Differences Similarities
COPD (chronic obstructive pulmonary disease) is the term doctors and other health care professionals use to describe a group of serious, progressive (worsens over time), chronic lung diseases that include emphysema, chronic bronchitis, and sometimes asthma. The number one cause of COPD or emphysema, is smoking, and smoking is the third leading cause of death in the US. When a person first develops COPD, he or she may not have any symptoms. As the disease progresses, the symptoms worsen and become more severe and include:
- Difficulty breathing with exertion or physical activity, which in the advanced stages, eventually leads to breathlessness all of the time.
- Chronic cough
- Excessive phlegm production
- Upper respiratory infections like the flu or common cold.
- A barrel-shaped chest
- A bluish tint to the skin from lack of oxygen
- Chest tightness
- varenicline (Chantix) to quit smoking
- The antidepressant and bupropion (Zyban) to reduce nicotine withdrawals
- Drugs that are prescribed for another condition (off label), for example, nortriptyline (Pamelor) and clonidine (Catapres)
- Short-term bronchodilators, for example, albuterol (Ventolin, Proventil)
- Long-term bronchodilators, for example, salmeterol (Serevent) and formoterol (Foradil)
- Anticholinergic bronchodilators, for example, ipratropium (Atrovent) and tiotropium (Spiriva)
- Combined drugs using steroids and long acting bronchodilators
- Roflumilast (Daxas, Daliresp)
You can prevent getting COPD or emphysema if you:
- Quit smoking and making healthy lifestyle changes
- Avoid secondhand smoke
- Avoid home and workplace air pollutants
- Prevent upper respiratory tract infections
There is a genetic cause of COPD called alpha-1 antitrypsin.
CDC. "Chronic Obstructive Pulmonary Disease (COPD)." Updated: Sep 16, 2016.
NIH; National Heart, Lung, and Blood Institute. "COPD National Action Plan." Updated: May 15, 2017.
NIH; National Heart, Lung, and Blood Institute. "What is COPD?" Updated: Apr 28, 2017.
U.S. Department of Health and Human Services. "COPD (Chronic Obstructive Pulmonary Disease)." Updated: Oct 31, 2014.
Victoria State Government. "Emphysema." Updated: Nov 2014.
Sharafkhaneh, A. et al. Emphysema. Proc Am Thorac Soc. 2008 May 1; 5(4): 475–477. doi: 10.1513/pats.200708-126ET
Boka, K. "Emphysema." Medscape. Updated: Aug 31. 2016.
Kleinschmidt, P. "Chronic Obstructive Pulmonary Disease (COPD) and Emphysema in Emergency Medicine." Medscape. Updated: Jun 08, 2017.
Drug or medication allergies are caused when the immune system mistakenly creates an immune response to a medication. Symptoms of a drug allergic reaction include:
- Itchy skin or eyes
The most common drugs that people are allergic to include:
- Penicillins and penicillin type drugs
- Sulfa drugs
Treatment may involve antihistamines or corticosteroids. An Epipen may be used for life-threatening anaphylactic symptoms.
Emphysema (Lung Condition)Emphysema is a COPD (chronic obstructive pulmonary disease) that often occurs with other obstructive pulmonary problems and chronic bronchitis. Causes of emphysema include chronic cigarette smoking, exposure to secondhand smoke, air pollution, and in the underdeveloped parts of the world. Symptoms of emphysema include chronic cough, chest discomfort, breathlessness, and wheezing. Treatments include medication and lifestyle changes.
How to Stop Coughing
Coughing is a reflex that helps a person clear their airways of irritants. There are many causes of an excessive or severe cough including irritants like cigarette and secondhand smoke, pollution, air fresheners, medications like beta blockers and ACE inhibitors, the common cold, GERD, lung cancer, and heart disease.
Natural and home remedies to help cure and soothe a cough include stay hydrated, gargle saltwater, use cough drops or lozenges, use herbs and supplements like ginger, mint, licorice, and slippery elm, and don't smoke.
Over-the-counter products (OTC)to cure and soothe a cough include cough suppressants and expectorants, and anti-reflux drugs.
Prescription drugs that help cure a cough include narcotic medications, antibiotics, inhaled steroids, and anti-reflux drugs like proton pump inhibitors or PPIs, for example, omeprazole (Prilosec), rabeprazole (Aciphex), and pantoprazole (Protonix).