- 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.
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:
Quick GuideAsthma Symptoms, Causes, and Medications
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.
Multimedia: Slideshows, Images & Quizzes
COPD (Chronic Obstructive Pulmonary Disease) Quiz
COPD is a combination of three conditions? Take this quiz to learn the three conditions that make up the pulmonary disease called...
Asthma Quiz: Test Your Medical IQ
Asthma is a chronic disease of the airways of the lungs, which can be managed with proper treatment. Triggered by two main...
What happens within the body when a person develops bronchitis? Take this quick quiz to learn the causes, symptoms, treatments,...
Picture of Bronchitis
Acute bronchitis usually comes on quickly and gets better after several weeks. See a picture of Acute Bronchitis and learn more...
Could I Be Allergic? Discover Your Allergy Triggers
Allergies are an overreaction of the immune system where the body's defenses react to substances such as pollen, food and more....
What is Asthma? Asthma Myths Debunked
There is currently no cure for asthma, and no specific, single cause for asthma has been identified. Take this quiz on asthma...
Home Allergy Quiz: Is Your Home Allergy-Proof?
Take this home allergy quiz and test your knowledge on allergens, dust mites, pollens and more to see how allergy-proof your home...
When Animal (Allergies) Attack: Pet Allergy Symptoms, Treatment
How do you control and relieve pet allergies? How do you prevent pet allergies? Learn dog and cat allergy symptoms, the cause of...
Bronchitis Symptoms and Treatments
Is bronchitis contagious? Learn about bronchitis, an inflammation of the lining of the lungs. Bronchitis can be aggravated from...
Asthma Symptoms, Causes, and Medications
What is asthma? Learn about asthma, a chronic inflammation disorder of the bronchiole tubes (airways). Discover information about...
Pictures of Allergy Relief Tips at Home: AC Filters, Electronic Air Cleaners, and More
Learn how a combination of medication, preventing allergens, and allergy relief products can reduce allergy symptoms and help you...
Nasal Irrigation: Natural Relief for Cold & Allergy Symptoms
Nasal irrigation can relieve sinus symptoms associated with colds & allergies. Learn how nasal irrigation can help unclog sinuses...
COPD Foods to Boost Your Health - COPD Diet Tips
Boost your energy and combat COPD with these diet tips. Which foods can help patients with COPD? Which foods to avoid for COPD?...
Worst Smog Cities in Pictures: Air Pollution, Ozone, and Asthma
Learn the worst smog cities in America. See the 10 cities with the most polluted, unclean and smoggy air....
COPD Lung Symptoms, Diagnosis, Treatment
COPD is a pulmonary disorder caused by obstructions in the airways of the lungs leading to breathing problems. Learn about COPD...
Out-of-Control Allergy Symptoms: Treatment Relief in Pictures
Learn 10 signs your allergies are out of control. See these surprising allergy symptoms and find out how to get relief for...
Asthma Attack Signs, Treatments, and Prevention
Look at the anatomy of an asthma attack. See these warning signs and symptoms to avoid an asthma emergency such as a persistent...
Nasal Allergy Attack: Causes, Triggers, Treatments
What causes allergies? What are your allergy triggers? Discover how allergies work, why our bodies react to them, whether...
10 Worst Asthma Cities in the U. S. in Pictures
Do you live in one of the 10 worst cites for asthma? There is no such thing as an asthma-free city, but some are more difficult...
10 Smart Exercises for People With COPD: Pictures
Learn 10 exercises for people with chronic obstructive pulmonary disease (COPD). If you have COPD, give your muscles more oxygen...
Related Disease Conditions
Asthma is a condition in which hyperreactive airways constrict and result in symptoms like wheezing, coughing, and shortness of...
COPD (Chronic Obstructive Pulmonary Disease) Symptoms, Causes, Stages, Life Expectancy
COPD or chronic obstructive pulmonary disease is a lung condition caused by smoking tobacco, exposure to secondhand smoke, and/or...
Cough (Chronic, Persistent Cough in Adults and Children)
Chronic cough is a cough that does not go away and is generally a symptom of another disorder such as asthma, allergic...
An allergy refers to a misguided reaction by our immune system in response to bodily contact with certain foreign substances. ...
Asthma: Over the Counter Treatment
Patients who have infrequent, mild bouts of asthma attacks may use over-the-counter (OTC) medications to treat their asthma...
There are many unusual symptoms of asthma, including sighing, difficulty sleeping, anxiety, chronic cough, recurrent walking...
Asthma in Children
Asthma in children manifests with symptoms such as coughing and wheezing. Rates of asthma in children are increasing. Asthma in...
Emphysema, Chronic Bronchitis, and Colds
If you have a COPD such as emphysema, avoiding chronic bronchitis and colds is important to avoid a more severe respiratory...
Emphysema is a COPD (chronic obstructive pulmonary disease) that often occurs with other obstructive pulmonary problems and...
Drug Allergy (Medication Allergy)
Drug or medication allergies are caused when the immune system mistakenly creates an immune response to a medication. Symptoms of...
Adult-onset asthma is asthma that is diagnosed in people over 20 years of age. Symptoms include wheezing, coughing, shortness of...
Exercise-induced asthma is asthma triggered by vigorous exercise. Symptoms include coughing, shortness of breath, chest...
There are two types of asthma medications: long-term control with anti-inflammatory drugs and quick relief from bronchodilators....
Chronic Bronchitis (Symptoms, Causes, Treatment, Remedies)
Chronic bronchitis is a cough that occurs daily with production of sputum that lasts for at least three months, two years in a...
Occupational asthma is a type of asthma caused by exposure to a substance in the workplace. Symptoms and signs include wheezing,...
Children's Cough Causes and Treatments
Children's cough causes include infection, acid reflux, asthma, allergies or sinus infection, whooping cough, and exposure to...
19 Tips on How to Stop a Cough
Coughing is a reflex that helps a person clear their airways of irritants. There are many causes of an excessive or severe...
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...
Treatment & Diagnosis
Medications & Supplements
- salmeterol, Serevent
- theophylline, Elixophyllin, Theo-24, (Theolair, Uniphyl Theo-Dur, and Slo-Phyllin-discontinued)
- albuterol (Accuneb, Ventolin & Proventil [all discontinued])
- ipratropium bromide inhaler, Atrovent, Atrovent HFA
- albuterol and ipratropium inhaler, Combivent, Combivent Respimat
- Advair Diskus, Advair HFA (fluticasone and salmeterol oral inhaler)
- xanthine derivatives-oral
- guaifenesin/theophylline/pseudoephedrine elixir - oral, Broncomar-1
- albuterol pediatric pre-mixed solution - inhalation, AccuNeb
- ipratropium solution - inhalation, Atrovent
- levalbuterol pre-mixed solution - inhalation, Xopenex
Prevention & Wellness
Health Solutions From Our Sponsors
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.