Bronchodilators are commonly used to treat asthma. Here is information about drug names (brand names and generic), typical daily doses, method of action, precautions and medication side effects for common bronchodilators. These dosages represent an average range for treatment. The precise effective dosage varies from person to person and depends on many factors. Do not make any change to your medication without consulting your doctor.
- Atrovent HFA (ipratropium, aerosol inhaler, non-CFC)—2 puffs every 6 hours; do not empty Atrovent HFA canister completely; discard after 200 sprays
- Spiriva HandiHaler (tiotropium, powder inhaler)—1 capsule every 24 hours; do not take capsule by mouth or use HandiHaler for any other medication than Spiriva
Anticholinergics block the chemical receptors that trigger mucus secretions in the nose and constriction of airways in the lungs. These drugs may be contraindicated if you have narrow-angle glaucoma, an enlarged prostate, kidney problems, or bladder obstruction. Be careful to avoid contact with eyes, which may worsen glaucoma and blur vision. Relative contraindication for people with tachycardia (rapid heart rate). May take up to 2 weeks for full effect. Not to be used as rescue therapy for severe wheezing.
Side effects of anticholinergics include dry mouth, bad taste in mouth. Less often they may cause constipation, increased heart rate, blurred vision and problems with urination. These drugs sometimes make bronchitis worse rather than better.
If you are taking anticholinergics, call your doctor if you develop:
- eye pain
- blurred vision or other visual changes
- nasal bleeding
- excessively dry nose
- swelling of face, mouth, or throat
- difficulty swallowing
- breathing problems
- Proventil HFA, Ventolin HFA (albuterol, aerosol inhaler)—2 puffs every 4-6 hours; to avoid contamination wash, shake, and air dry HFA containers weekly; discard HFA containers after 200 sprays
- Xopenex HFA (levalbuterol, aerosol inhaler)—1-2 puffs every 4-6 hours; to avoid contamination use individual vial of Proventil immediately after opening
- Foradil Aerolizer (formoterol, powder inhaler)—1 inhalation 2x/day; morning and evening. Keep powder inhaler dry. Do not wash. Never use with a spacer and do not exhale into device.
- Serevent Diskus (salmeterol, powder inhaler)—1 inhalation 2x/day; morning and evening. Keep powder inhaler dry. Do not wash. Never use with a spacer and do not exhale into device.
Beta2 agonists stimulate the release of cyclic AMP, a molecule that relaxes air passages in the lung and inhibits allergic reactions. Short-acting medications can exacerbate pre-existing heart problems or diabetes. May interact with drugs used for heart or kidney disease or depression. Relative contraindication for people with tachycardia. Exceeding prescribed dose can be fatal. Side effects include palpitations, rapid heart rate, tremor, chest pain, dizziness, nervousness, cough, nausea, vomiting and throat irritation.
Call your doctor if your symptoms suddenly get worse; you develop breathing problems; swelling of face, mouth, or throat; difficulty swallowing; or rash.
Long-acting medications may increase risk of death from asthma. Can exacerbate pre-existing heart problems or diabetes. Not to be used by people whose asthma is controlled by other medications. Not to be used for sudden breathing problems. Do not exceed recommended dosage. Side effects include increased blood pressure, fast and irregular heartbeat, chest pain, headache, tremor, nervousness and throat irritation.
Call your doctor if your asthma is getting worse, not better; you use more than 4 doses per day for 2 consecutive days or use more than 200 doses in 8 weeks.
- Combivent (albuterol and ipratropium, standard inhaler)—2 puffs 4x/day; to be phased out by December 31, 2013, because it contains ozone-depleting chlorofluorocarbons. Talk to your doctor about switching to an environmentally-friendly alternative. Wash inhaler and dry weekly to avoid contamination. Discard after 200 sprays.
- DuoNeb (albuterol and ipratropium, nebulizer)—1 vial 4x/day; keep vials in foil pouch before use
- Advair Diskus (salmeterol and fluticasone, powder inhaler)—1 inhalation 2x/day; keep inhaler dry. Do not use with spacer and do not exhale into inhaler.
- Advair HFA (salmeterol and fluticasone, aerosol inhaler, non-CFC)—2 puffs 2x/day; wash, shake, and air dry HFA containers weekly. Discard HFA containers after 200 sprays.
- Symbicort (budesonide and formoterol)—1 inhalation 2x/day; rinse your mouth with water after each use.
Combivent and DuoNeb cause the release of molecules that relax the muscle in breathing tubes. May worsen heart problems, diabetes, urinary problems, thyroid disorders, seizure disorders, or glaucoma. Avoid spraying into eyes. Combivent may cause coughing. Side effects generally fewer than for either component alone. DuoNeb may cause lung disease, sore throat, chest pain, constipation, diarrhea, bronchitis, urinary tract infection, leg cramps, nausea, upset stomach, voice changes and pain. Call your doctor if you develop eye pain, vision changes, breathing problems that get worse and not better, hives, rash, swelling of face or throat or difficulty swallowing.
Fluticasone, a corticosteroid, helps prevent inflammation of breathing passages, while salmeterol relaxes breathing passages. Budesonide, a corticosteroid, helps decrease inflammation in the lungs, while formoterol, a long-acting beta2 agonist, helps the muscles around the airways stay relaxed. Long-acting combination agents should not be used with long-acting beta2 agonists.
Do not exceed recommended dosage. May increase risk of death from asthma problems. Not to be used for sudden breathing problems. Should be used only for people whose asthma is not treated adequately by other medications. These medications may worsen heart, thyroid, or liver problems, diabetes, blood pressure, seizures or osteoporosis. May increase risk of pneumonia in people with COPD.
Side effects of long-acting combination agents include:
- hives or swelling of face or throat
- breathing problems
- increased blood pressure
- fast and irregular heartbeat
- chest pain
- reduced bone mineral density
- eye problems including glaucoma and cataracts
Call your doctor if your breathing gets worse quickly, not better; you need to use more than 4 doses for 2 or more consecutive days or one whole canister in 8 weeks; you develop rash, difficulty swallowing, breathing problems, swelling of face, mouth, or throat.
- Theochron, Theo-24, Theolair, Uniphyl (theophylline, extended-release capsule)—300-600 mg; take at approximately the same time each day and do not exceed the prescribed dose. Uniphyl: Should be taken with food, but can be taken without. If taken with food, consistently take it with food. If taken without food, consistently take it without food.
Methylxanthine derivatives relax smooth muscles and suppresses the airway response to stimuli. They should be used with caution in people who have active peptic ulcers, seizure disorders, or heart arrhythmias. The metabolism of methylxanthines can be altered by other medications. Check with your doctor or pharmacist whenever another drug is prescribed. Uniphyl: Do not chew or crush tablets.
Side effects include restlessness, insomnia, loss of appetite, nervousness, irritability and nausea. Call your doctor if you experience nausea, vomiting, persistent headache or rapid heartbeat.