Back to Basics: Bronchodilators
Back in the 1980s, when I was a child with asthma, there weren’t many different options for asthma control. I remember my first albuterol/rescue inhaler was a “Rotahaler” where you had to put a little capsule inside and twist it and then suck the medication in.
I was excited when, a few years later, my albuterol Rotahaler was switched to an actual inhaler. It was so much easier to use and didn’t involve many steps to get relief when breathing was difficult. As a respiratory therapist, I am asked often what the differences are between inhaler types. For this post, I am going to focus on bronchodilators.
What are bronchodilators?
Bronchodilators are used to reverse acute bronchospasm and are the most common inhalers prescribed for asthma. There are two different types of bronchodilator inhalers--short- and long-acting. They are both very effective and can both be prescribed simultaneously to treat asthma.1
The two types of bronchodilators
Short-acting beta agonists
Short-acting beta-2 agonist (SABA) bronchodilators are one type. They can take effect quickly--within 5-10 minutes--and can last for up to 4-6 hours. SABA medications help relax and dilate the smooth muscle in the lungs which tightens during an asthma flare-up. Short-acting bronchodilators are also used to treat exercise-induced asthma and are taken 15-30 min before exercise.2
Albuterol is the most common bronchodilator/rescue inhaler. The brand names of albuterol include ProAir, Ventolin, and Proventil. Levalbuterol (brand name Xopenex) is another SABA rescue inhaler, which is less commonly prescribed.
SABA inhalers are often referred to as “rescue” inhalers. These are generally the only inhaler prescribed for mild intermittent asthma.3 Don’t forget to use a spacer with your rescue inhaler! Spacers are to be used only with HFA inhalers (the traditional spray type) and not the dry powder nor respimat type.4
Long-acting beta agonists
Long-acting beta agonists (LABA) are the other type of bronchodilator used to help control asthma. They are not quick-relief medications. The effects can last up to 12 hours or more. They work similarly to SABA inhalers in that they cause dilation and relax the smooth muscles in the lungs which make it easier to breathe.5
LABA inhalers should always be used in conjunction with an inhaled corticosteroid.5 Stand-alone long-acting beta-agonist inhalers include Serevent, Arcapta (which is approved for COPD, not asthma), and Striverdi. Common combination steroid/LABA inhalers include Advair, Breo, Dulera, and Symbicort.
Bronchodilators have limitations
It is important to note that bronchodilators are very effective in reversing bronchospasm that comes with an acute asthma exacerbation. However, bronchodilators won’t do anything to reverse the inflammation that also happens in the lungs when your asthma is flaring. If the lung inflammation continues, bronchodilators will only provide temporary relief.6
A dear friend and amazing asthma educator Lorene once said it's like putting a bandaid on something that needs a tourniquet. The bandaid is the rescue inhaler while the tourniquet is a corticosteroid inhaler which brings down that chronic inflammation.
If you are needing to use your rescue inhaler more than it is prescribed, your asthma is not under control. Asthma is classified as uncontrolled if you are needing to use your rescue inhaler for asthma symptoms two times or more per week.6 Talk to your doctor if you are concerned that your asthma is not controlled!
What type of bronchodilator do you use? Share with us in the comments below!
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