Inhaled Bronchodilators

Reversal of airflow limitation via relaxation of airway smooth muscle tissue

Long-acting formulations used for chronic therapy and short-acting formulations for acute symptom relief.

Diagnosis of COPD: FEV ₁ /FVC <0.70 after bronchodilator treatment.

Two classes: Beta ₂ agonist and anticholinergic.

• Inhalational administration decreases systemic effects, increases potency, and shortens time to onset.

• MDI, DPI, or NEB routes.

• Airway responsiveness is measured by improvement of FEV ₁ .

• Combined use of beta ₂ and anticholinergic is superior to either used as single therapy.

• Often combined with an inhaled corticosteroid.

Beta ₂ agonist:

• Short-acting (albuterol, levalbuterol, fenoterol, terbutaline): Onset within about 5 min; peak 30 min to 1 h; duration 4 to 6 h; levalbuterol 6 to 8 h

• Long-acting: Duration 12 h (arformoterol, formoterol, olodaterol, salmeterol), 24 h (indacaterol)

Anticholinergic:

• Short-acting (ipratropium bromide, oxitropium): Onset 1 to 3 h; duration 6 to 8 h

• Long-acting (tiotropium): Duration 24 h

Beta ₂ agonist:

• Sinus tachycardia, cardiac arrhythmias

• Hypokalemia/hypomagnesemia

• Paradoxical bronchospasm

Anticholinergic:

• Nausea

• Acute angle glaucoma

• Urinary retention

• Tachycardia