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A bronchodilator is a substance that dilates the bronchi and bronchioles, decreasing resistance in the respiratory airway and increasing airflow to the lungs. Bronchodilators may be endogenous (originating naturally within the body), or they may be medications administered for the treatment of breathing difficulties. They are most useful in obstructive lung diseases, of which asthma and chronic obstructive pulmonary disease are the most common conditions. Although this remains somewhat controversial, they might be useful in bronchiolitis and Bronchiectasis.They are often prescribed but of unproven significance in restrictive lung diseases.
Bronchodilators are either short-acting or long-acting. Short-acting medications provide quick or "rescue" relief from acute bronchoconstriction. Long-acting bronchodilators help to control and prevent symptoms. The three types of prescription bronchodilating drugs are β2-agonists (short- and long-acting), anticholinergics (short-acting), and theophylline (long-acting).
Short-acting β2-agonists
These are quick-relief or "rescue" medications that provide quick, temporary relief from asthma symptoms or flare-ups. These medications usually take effect within 20 minutes or less, and can last from four to six hours. These inhaled medications are best for treating sudden and severe or new asthma symptoms. Taken 15 to 20 minutes ahead of time, these medications can also prevent asthma symptoms triggered by exercise or exposure to cold air. Some short-acting β-agonists (for example salbutamol) are specific to the lungs; they are called β2-agonists and can relieve bronchospasms without unwanted cardiac (β1) side effects of nonspecific β-agonists (for example, ephedrine or epinephrine).
Long-acting β2-agonists
These are long-term medications taken routinely in order to control and prevent bronchoconstriction. They are not intended for fast relief. These medications may take longer to begin working, but relieve airway constriction for up to 12 hours. Commonly taken twice a day with an anti-inflammatory medication, they maintain open airways and prevent asthma symptoms, particularly at night.
Salmeterol and Formoterol are examples of these.
Anticholinergics
Some examples of anticholinergics are tiotropium (Spiriva) and ipratropium bromide.
Tiotropium is a long-acting, 24 hour, anticholinergic bronchodilator used in the management of chronic obstructive pulmonary disease (COPD).
Only available as an inhalant, ipratropium bromide is used in the treatment of asthma and COPD. It relieves acute or new asthma symptoms. It will not stop an asthma attack already in progress. Because it has no effect on asthma symptoms when used alone, it is most often paired with a short-acting β2-agonist. While it is considered a relief or rescue medication, it can take a full hour to begin working. For this reason, it plays a minor role in asthma treatment. Dry throat is the most common side effect. If the medication gets in contact with the eyes, it may cause blurred vision for a brief time.
Other
Available in oral and injectable form, theophylline is a long-acting bronchodilator that prevents asthma episodes. It belongs to the chemical class methyl xanthines (along with caffeine). It is prescribed in severe cases of asthma or those that are difficult to control. It must be taken 1–4 times daily, and doses cannot be missed. Blood tests are required to monitor therapy and to indicate when dosage adjustment is necessary. Side effects can include nausea, vomiting, diarrhea, stomach or headache, rapid or irregular heart beat, muscle cramps, nervous or jittery feelings, and hyperactivity. These symptoms may signal the need for an adjustment in medication. It may promote acid reflux, also known as GERD, by relaxing the lower esophageal sphincter muscle. Some medications, such as seizure and ulcer medications and antibiotics containing erythromycin, can interfere with the way theophylline works. Coffee, tea, colas, cigarette-smoking, and viral illnesses can all affect the action of theophylline and change its effectiveness. A physician should monitor dosage levels to meet each patient's profile and needs.
For inhalation only: Do not use unless a doctor has said you have asthma. If you are now taking a prescription monoamine oxidase inhibitor (MAOI) (certain drugs for depression, psychiatric, or emotional conditions, or Parkinson's disease), or for 2 weeks after stopping the MAOI drug. if you do not know if you prescription drug contains an MAOI, ask a doctor or pharmacist before taking this product. Ask a doctor before use if you have: heart disease, thyroid disease, high blood pressure, ever been hospitalized for asthma, trouble urinating due to enlarged prostate gland, diabetes. Ask a doctor or pharmacist before use if you are taking any prescription drug for asthma. When using this product: overuse may cause nervousness, rapid heart beat, and heart problems. Do not continue to use, but seek medical assistance immediately if symptoms are not relieved within 20 minutes or become worse. Do not puncture or throw into incinerator. Contents under pressure. Do not use or store near open flame or heat above 120 degrees F. May cause bursting. Contains CFC 12, 114, substances which harm public health and environment by destroying ozone in the upper atmosphere. If pregnant or breast-feeding, ask a health professional before use. Keep out of reach of children. In case of overdose, get medical help or contact a poison control center right away.
Epinephrine is used to treat wheezing and shortness of breath that commonly occur with asthma. Controlling these symptoms can decrease time lost from work or school. Epinephrine is a bronchodilator that works by opening breathing passages to make breathing easier. Use this medication only if you have been told by your doctor that you have asthma.
How to use Bronchial Asthma Relief Oral
Read the Patient Information Leaflet for instructions on proper use of this medication and the proper cleaning of the mouthpiece. Consult your doctor or pharmacist if you have any questions.
Shake the canister well before each inhalation. Follow all directions on the product package. If you are uncertain about any of the information, consult your doctor or pharmacist. If you take other asthma drugs by mouth or with inhaling devices, ask your doctor about how to correctly take this medication with your other asthma medicines.
Use this medication exactly as directed in the product package. Inhale by mouth as needed. Take the cap off the mouthpiece. Place the mouthpiece near your mouth and exhale. Place the mouthpiece fully into your mouth and press the inhaler as you breathe in deeply. Hold your breath for as long as comfortable to allow the drug to be absorbed. If more than one inhalation is needed, wait at least 1 full minute between inhalations. Do not use again for three hours. If your breathing does not get better in 20 minutes after using this medication, or if your breathing worsens, seek immediate medical attention.
Rinse mouth after using this medication to help prevent dryness and throat irritation. Do not take more of this medication or take it more often than recommended by the product package or your doctor.
Clean the mouthpiece after each use as directed in the Patient Information Leaflet. It should also be cleaned at any time that it appears to be clogged or is not working correctly.
Try to keep track of the number of inhalations used from each canister. Discard the canister after you have used the number of inhalations marked on the product package. Do not float the inhaler in water to test if any more drug is left in it.
Headache, nausea, vomiting, nervousness, dizziness, shaking (tremor), trouble sleeping, stomach upset, sweating, dry mouth, bad taste, cough, or sore throat may occur. If any of these effects persist or worsen, notify your doctor or pharmacist promptly.
If your doctor has directed you to use this medication, remember that he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.
Tell your doctor immediately if any of these unlikely but serious side effects occur: fast/pounding/irregular heartbeat, muscle cramps, weakness, mental/mood changes (e.g., anxiety, hallucinations).
Seek immediate medical attention if any of these rare but very serious side effects occur: chest pain.
Rarely, this medication has caused severe (rarely fatal), sudden worsening of breathing problems/asthma (paradoxical bronchospasm). If you experience sudden wheezing, seek immediate medical attention.
A very serious allergic reaction to this drug is rare. However, seek immediate medical attention if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.
This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.
Before taking epinephrine, tell your doctor or pharmacist if you are allergic to it; or to similar bronchodilators (e.g., albuterol, levalbuterol, salmeterol); or to sympathomimetic drugs (e.g., pseudoephedrine); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.
If you have any of the following health problems, consult your doctor or pharmacist before using this product: heart disease (e.g., high blood pressure, abnormal heart rhythm, coronary insufficiency), seizures, overactive thyroid (hyperthyroidism), diabetes, low blood potassium level (hypokalemia), glaucoma (narrow-angle), Parkinson's disease, urination problems (e.g., trouble urinating due to enlarged prostate).
This drug may make you dizzy. Do not drive, use machinery, or do any activity that requires alertness until you are sure you can perform such activities safely. Limit alcoholic beverages.
Caution is advised when using this drug in the elderly because they may be more sensitive to the effects of the drug, especially the effects on the heart.
During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.
It is not known whether this drug passes into breast milk. Consult your doctor before breast-feeding.
If you are taking this product under your doctor's direction, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with them first.
Avoid taking MAO inhibitors (isocarboxazid, linezolid, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, selegiline, tranylcypromine) or tricyclic antidepressants (e.g., amitriptyline, nortriptyline) within 2 weeks before, during, and after treatment with this medication. In some cases a serious, possibly fatal drug interaction may occur.
Before using this product, tell your doctor or pharmacist if you use any of the following: other asthma drugs (e.g., levalbuterol, salmeterol), some beta blockers (such as propranolol), inhaled anesthetics (e.g., halothane, isoflurane), other sympathomimetic drugs (e.g., ephedrine), certain "water pills" (diuretics that cause potassium loss such as furosemide, hydrochlorothiazide).
Caffeine can increase the side effects of this medication. Limit drinking large amounts of beverages containing caffeine (coffee, tea, colas) or eating large amounts of chocolate.
This document does not contain all possible interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist.
If overdose is suspected, contact a poison control center or emergency room immediately.
Notes
Do not share this medication with others.
If this medication is used for an extended time, laboratory and/or medical tests (e.g., blood sugar/mineral levels, blood pressure, eye exams) should be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.
Talk with your doctor about making changes to your lifestyle that may decrease the side effects of this medication (e.g., weight-bearing exercise, dietary changes including controlling salt intake and getting more potassium/calcium).
Missed Dose
If you are taking this medication daily and on a regular schedule, and you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up.
If you are taking this medication every other day or are slowly reducing your dose, and you miss a dose, then contact your doctor or pharmacist immediately to establish a new dosing schedule.
Storage
Store at room temperature between 68-77 degrees F (20-25 degrees C) away from light and moisture. Do not freeze. Do not store in the bathroom. Keep all medicines away from children and pets. After the bottle has been opened, discard the medication after 90 days.
Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.
Information last revised April 2013. Copyright(c) 2013 First Databank, Inc.
