Bronchodilators

Bronchodilators are a type of medicine used to prevent and treat the symptoms of chronic obstructive pulmonary disease (COPD). These symptoms include wheezing, breathlessness, and chest tightness.¹

Bronchodilating drugs are a key part of managing COPD symptoms. Many people with COPD use at least one kind of bronchodilator as part of their treatment regimen. It is also common to need more than one type of drug to manage different parts of the disease. This is because different bronchodilators can work in different ways to relieve symptoms.^1-3

How do bronchodilators work for COPD?

People with COPD have airways that are irritated and inflamed. This can cause the band of muscles that surround the airways to tighten up all of a sudden, which is called a bronchospasm. When this happens, the airways get narrower, and it makes it difficult to breathe.²

Bronchodilators treat bronchospasms by acting on these muscles around the airways. The drugs can make the muscles relax when they are too tight. Bronchodilators can also keep the muscles from tightening up again. When the muscles are relaxed, the airways widen, allowing more air to travel in and out of the lungs. This can make breathing easier for people with COPD.^1,2

People usually take bronchodilators using an inhaler or a nebulizer:¹

• Metered-dose inhalers deliver the drug as a mist or spray that comes from a canister and is inhaled by mouth.
• Dry-powder inhalers deliver a powder through the inhaler instead of a mist or spray.
• Nebulizers are machines that change medicine from liquid form into a fine mist that can be more easily inhaled in the lungs.

Examples

Some kinds of bronchodilators are used in rescue inhalers. This means they are used as needed to relieve bronchospasms and breathing symptoms that get worse very quickly. This helps to keep flare-ups from becoming more severe. These medicines are often called short-acting bronchodilators.¹

During the early stages of COPD, a rescue inhaler may be the only drug a person needs to manage breathing symptoms.^2,3

Other kinds of bronchodilators are used as maintenance therapy. They are taken on an ongoing, regular basis to help prevent and reduce the daily symptoms of COPD. These medicines are often called long-acting bronchodilators.^1-3

Maintenance therapy is not used to treat bronchospasms or sudden symptoms. People with later stages of COPD use maintenance drugs more often.^1-3

Both short-acting and long-acting bronchodilators are described by how they work in your body. There are beta-agonists and muscarinic antagonists.¹

Other bronchodilators may be used for people with severe COPD or people who do not respond well to other drugs.¹

Short-acting bronchodilators

Short-acting bronchodilators start working to relieve COPD symptoms quickly. But their effects do not last very long. Short-acting beta-agonists (SABAs) are the most common type of drug in a rescue inhaler. SABAs can start relieving symptoms in 3 to 5 minutes. But their effects only last about 4 to 6 hours.^1,2

Short-acting muscarinic antagonists (SAMAs) start working more slowly than SABAs do. SAMAs take about 15 minutes to start working, so they cannot be used in a rescue inhaler. But SAMAs are used as a maintenance therapy for COPD.^1,2

Examples of SABAs include:⁴

• Albuterol
• Xopenex^® HFA (levalbuterol)

Examples of SAMAs include:^1,2

• Atrovent^® HFA (ipratropium bromide)

Long-acting bronchodilators

Long-acting bronchodilators are often taken daily when a person is in the later stages of COPD. These drugs have to be taken every day to work well. They help to provide steadier relief for COPD symptoms. Long-acting beta-agonists (LABAs) are a type of bronchodilator that should be taken every day to maintain control and prevent COPD symptoms. ³

Examples of LABAs include:⁴

• Brovana^® (arformoterol)
• Perforomist^® (formoterol fumarate)
• Serevent^® Diskus (salmeterol xinafoate)
• Striverdi^® Respimat^® (olodaterol)

Long-acting muscarinic antagonists (LAMAs) are another type of bronchodilator that may be used with inhaled steroids in people who cannot take LABAs. Examples of LAMAs include:^3,4

• Incruse Ellipta (umeclidinium)
• Spiriva^® HandiHaler^®, Spiriva^® Respimat^® (tiotroprium bromide)
• Tudorza^® Pressair^® (aclidinim bromide)
• Yupelri^® (revefenacin)

Combination therapies

Combination therapies for COPD contain 2 or more drugs in a single inhaled dose. Combining these drugs works better than either drug would work alone. The single dose is also more convenient for many people. Combination therapies include:^1,2

• Short-acting combination inhalers
• Long-acting combination inhalers
• Inhaled steroids with short-acting drugs
• Inhaled steroids with long-acting drugs

Examples of combination ​​bronchodilators include:⁴

• Breo^® Ellipta^® (fluticasone furoate and vilanterol trifenatate powder)
• Combivent® Respimat^® (ipratropium bromide and albuterol)
• Stiolto^® Respimat^® (tiotropium bromide and olodaterol)
• Symbicort^® (budesonide and formoterol fumarate dehydrate)

What are the possible side effects?

Side effects can vary depending on the specific drug you are taking. Some of the most common side effects of ​​bronchodilators include:¹

• Trembling, especially in the hands
• Headache
• Dry mouth
• Increased heart rate
• Muscle cramps
• Cough
• Nausea, vomiting
• Diarrhea

These are not all the possible side effects of bronchodilators. Talk to your doctor about what to expect when taking a bronchodilator. You also should call your doctor if you have any changes that concern you when taking a bronchodilator.

Other things to know

Bronchodilators stand as a fundamental element in COPD management, providing tailored relief for people based on their symptoms and the stage of their condition. Talk to your doctor about which drug might be best for you.¹

Some bronchodilators may interact with other medicines. Before beginning treatment for COPD, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you are taking. This includes over-the-counter drugs.