Examples
Prescription beta2-agonists
|
| albuterol (short-acting) | Proventil, Ventolin |
| arformoterol (long-acting) | Brovana |
| formoterol (long-acting) | Foradil, Perforomist |
| levalbuterol (short-acting) | Xopenex |
| metaproterenol (short-acting) | |
| pirbuterol (short-acting) | Maxair |
| salmeterol (long-acting) | Serevent |
| terbutaline (short-acting) | |
Prescription long-acting beta2-agonist and corticosteroid combination
|
| formoterol and budesonide | Symbicort |
| salmeterol and fluticasone | Advair |
Prescription short-acting beta2-agonist and anticholinergic combination
|
| albuterol and ipratropium | Combivent, DuoNeb |
Beta2-agonists are available in metered-dose
inhaler (MDI),
nebulizer, pill, injected, and syrup forms. Some
beta2-agonists may be available in multiple forms. Your doctor will help you
decide which form is best for you.
There are 2 types of
beta2-agonists: short-acting and long-acting. The short-acting type relieves
symptoms and the long-acting type helps prevent breathing problems.
Short-acting beta2-agonists are used for treating stable COPD in a person whose
symptoms come and go (intermittent symptoms). Long-acting beta2-agonists are
effective and convenient for preventing and treating COPD in a person whose
symptoms do not go away (persistent symptoms).
How It Works
Beta2-agonists are
bronchodilators. This means that they relax and
enlarge (dilate) the airways in the lungs, making breathing easier.
Why It Is Used
Beta2-agonists are considered
first-line therapy for the treatment of stable
chronic obstructive pulmonary disease (COPD) with
symptoms that come and go (intermittent symptoms). They are used for both
short- and long-term relief of symptoms.
Beta2-agonists also may
be used before exercise to reduce breathing difficulties.
Salmeterol, formoterol, or arformoterol may be taken to prevent shortness
of breath or coughing that may keep you from exercising.
How Well It Works
Studies indicate that inhaled
beta2-agonists are effective in treating symptoms of COPD and improving lung
function as measured by tests (spirometry).1 They also reduce the
number of
COPD exacerbations. There is no evidence of their
effect on the progression of the disease.5
Compared to
placebo:
- Inhaled short-acting beta2-agonists are
effective in treating a person whose symptoms are rapidly getting worse (COPD exacerbation) and improving lung function and shortness of breath in
stable COPD.3, 5
- Inhaled long-acting beta2-agonists improve lung
function and improve symptoms such as shortness of breath.5
Results vary from one person to the next. For some people
with COPD, beta2-agonist medicines make breathing much easier. For others, they
do not help.
Combining medicines may help your lung function.
Using a beta2-agonist:
- With an anticholinergic may help your lung
function more than using either medicine alone.5
- With an inhaled corticosteroid may result in improved shortness of
breath and less use of relief medicine compared to
placebo or compared to either medicine used
alone.4, 2 The combination also
resulted in fewer COPD exacerbations compared with placebo, but it increased
the risk of
pneumonia.4
Combining medicines also may reduce the risk of side effects compared to increasing the dose of one medicine.6
Side Effects
Side effects are much more likely to
occur when you take this medicine as a pill or injection than when you use the
inhaled form. Side effects can include:
- Anxiety.
- Muscle
tremors.
- Nervousness.
- Increased or irregular heartbeat
(palpitations).
The U.S. Food and Drug Administration (FDA) has reported
that arformoterol, formoterol, and salmeterol may make breathing more
difficult. If your wheezing gets worse after taking these medicines, call your
doctor right away.
See Drug Reference for a full list of side
effects. (Drug Reference is not available in all systems.)
What To Think About
While short-acting beta2-agonists
may be the first choice for treating symptoms of mild COPD that come and go
(intermittent symptoms), anticholinergics generally are regarded as the
first-line treatment for persistent symptoms, in most cases of COPD.
Inhalation is the preferred method of taking beta2-agonists. This method
reduces the chance of side effects and makes the medicine more effective. Pills
and injections are reserved for those who cannot use a metered-dose inhaler
(MDI) or nebulizer.
Nebulizers normally are no better at
delivering beta2-agonists deep into the lungs than a properly used metered-dose
inhaler. Sometimes your doctor may prescribe a nebulizer. Although a nebulizer
can deliver a very large dose of medicine, it also may increase side effects of
the medicine.
Most doctors recommend that everyone using an
inhaler also use a
spacer. Use of a spacer is especially important when
using an inhaler containing a steroid medicine. But you should not use a dry
powder inhaler (DPI) with a spacer.
Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.
References
Citations
- Celli BR, et al. (2008). Effect of pharmacotherapy on rate of decline of lung function in chronic obstructive pulmonary disease: Results from the TORCH study. American Journal of Respiratory and Critical Care Medicine, 178(4): 332–338.
- Hanania NA, et al. (2003). The efficacy and safety of
fluticasone propionate (250 micrograms)/salmeterol (50 micrograms) combined in
the Diskus Inhaler for the treatment of COPD. Chest,
124: 834–843.
- Stoller JK (2002). Acute exacerbations of chronic
obstructive pulmonary disease. New England Journal of Medicine, 346(13): 987–994.
- Calverley PM, et al. (2007). Salmeterol and
fluticasone propionate and survival in chronic obstructive pulmonary disease.
New England Journal of Medicine, 356(8):
775–789.
- Kerstjens H, et al. (2005). Chronic
obstructive pulmonary disease. Clinical Evidence (13):
1923-1947.
- Global Initiative for Chronic Obstructive
Lung Disease (GOLD) (2005). Executive summary (updated 2005). In
Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease. Available online:
http://www.goldcopd.com/GuidelinesResources.asp?I1=2&I2=0.
Credits
| By | Healthwise Staff |
|---|
| Primary Medical Reviewer | Caroline S. Rhoads, MD - Internal Medicine |
|---|
| Specialist Medical Reviewer | Ken Y. Yoneda, MD - Pulmonology |
|---|
| Last Revised | May 4, 2010 |
|---|
Celli BR, et al. (2008). Effect of pharmacotherapy on rate of decline of lung function in chronic obstructive pulmonary disease: Results from the TORCH study. American Journal of Respiratory and Critical Care Medicine, 178(4): 332–338.
Hanania NA, et al. (2003). The efficacy and safety of
fluticasone propionate (250 micrograms)/salmeterol (50 micrograms) combined in
the Diskus Inhaler for the treatment of COPD. Chest,
124: 834–843.
Stoller JK (2002). Acute exacerbations of chronic
obstructive pulmonary disease. New England Journal of Medicine, 346(13): 987–994.
Calverley PM, et al. (2007). Salmeterol and
fluticasone propionate and survival in chronic obstructive pulmonary disease.
New England Journal of Medicine, 356(8):
775–789.
Kerstjens H, et al. (2005). Chronic
obstructive pulmonary disease. Clinical Evidence (13):
1923-1947.
Global Initiative for Chronic Obstructive
Lung Disease (GOLD) (2005). Executive summary (updated 2005). In
Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease. Available online:
http://www.goldcopd.com/GuidelinesResources.asp?I1=2&I2=0.
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