Bronchodilator Therapy

Introduction to Bronchodilators

The American Academy of Allergy, Asthma, and Immunology recommends the use of bronchodilators, which are classified into three major categories: beta-2 agonists, anticholinergics, and methylxanthines, each with different mechanisms of action and duration of effect 1

The American College of Allergy, Asthma, and Immunology suggests that short-acting beta-2 agonists (SABAs), such as albuterol, levalbuterol, and pirbuterol, are used for quick relief of acute symptoms and prevention of exercise-induced bronchoconstriction (EIB) 1, 2
The National Asthma Education and Prevention Program recommends that SABAs have an onset of action within minutes and a duration of 4-6 hours 2
The American Thoracic Society indicates that increasing use of SABA treatment or use >2 days/week for symptom relief generally indicates inadequate asthma control 1
The Global Initiative for Asthma recommends that regular scheduled daily use of SABAs is not recommended 1
The American Academy of Allergy, Asthma, and Immunology suggests that long-acting beta-2 agonists (LABAs), such as salmeterol, formoterol, indacaterol, olodaterol, and vilanterol, provide bronchodilation for at least 12 hours after a single dose 1
The National Heart, Lung, and Blood Institute recommends that LABAs are used in combination with inhaled corticosteroids (ICS) for long-term control in moderate or severe persistent asthma 1, 3

The European Respiratory Society suggests that short-acting muscarinic antagonists (SAMAs), such as ipratropium bromide, inhibit muscarinic cholinergic receptors and reduce intrinsic vagal tone of the airway 1
The American College of Chest Physicians recommends that SAMAs provide additive benefit to SABAs in moderate or severe exacerbations in emergency settings 1
The British Thoracic Society indicates that long-acting muscarinic antagonists (LAMAs), such as tiotropium, aclidinium, umeclidinium, and glycopyrronium, may be beneficial in patients with symptoms of breathlessness in bronchiectasis 6, 7

The American Academy of Allergy, Asthma, and Immunology suggests that theophylline is a mild to moderate bronchodilator 1
The National Asthma Education and Prevention Program recommends that sustained-release theophylline is used as alternative (not preferred) therapy for step 2 care in mild persistent asthma or as adjunctive therapy with ICS 1

The Global Initiative for Chronic Obstructive Lung Disease recommends that a SAMA plus SABA is more effective than SABA alone for preventing acute exacerbations in COPD 4, 5

The American Thoracic Society indicates that reversibility testing to bronchodilators may help identify patients with co-existing asthma but is not required to benefit from bronchodilator therapy 7
The European Respiratory Society suggests that for patients with bronchiectasis and co-existing COPD or asthma, bronchodilator treatment should follow the respective guideline recommendations 6, 7