Bronchodilators: Uses, common brands, and safety info

If you or a loved one has asthma or COPD (chronic obstructive pulmonary disease), you may use (or have heard of) a medication called a bronchodilator. Bronchodilators are medications that are approved by the U.S. Food and Drug Administration (FDA). They are used in the prevention or treatment of asthma and/or COPD (depending on the product), such as wheezing, coughing, chest pain, and shortness of breath.

This article will discuss bronchodilator uses, common brand names, safety information, and more.

Below is a list of common bronchodilators, with links to the SingleCare coupon and information pages.

Other prescription bronchodilators

• AccuNeb (albuterol) inhalation solution for nebulizer

• Albuterol oral tablets

• Albuterol oral syrup

• Anoro (umeclidinium/vilanterol) Ellipta

• Bevespi (glycopyrrolate/formoterol) Aerosphere

• Brovana (arformoterol) inhalation solution for nebulizer

• DuoNeb (ipratropium bromide and albuterol) inhalation solution for nebulizer

• Incruse (umeclidinium) Ellipta

• Perforomist (formoterol) inhalation solution for nebulizer

• ProAir (albuterol) Digihaler

• Serevent Diskus (salmeterol) inhalation powder

• Stiolto Respimat (tiotropium/olodaterol) inhalation mist

• Striverdi Respimat (olodaterol) inhalation mist

• Theophylline (available as a tablet, capsule, oral solution)

• Tudorza (aclidinium) Pressair

• Utibron (indacaterol/glycopyrrolate) Neohaler

• Xopenex HFA (levalbuterol) metered-dose inhaler

• Xopenex (levalbuterol) inhalation solution for nebulizer

Other over-the-counter (OTC) bronchodilators

• Bronkaid Max (ephedrine) tablets

• Primatene (ephedrine) tablets

• Primatene Mist (epinephrine) inhaler

Additionally, some LABA/steroid combination products are listed below. These contain a corticosteroid and a long-acting beta-agonist (LABA) in one product—because a LABA must always be prescribed in combination with a steroid. We will not be discussing these combination products in this article, as steroids come with their own set of restrictions, side effects, warnings, and drug interactions. 

• Advair (fluticasone/salmeterol) 

• Airduo (fluticasone/salmeterol) 

• Dulera (mometasone/formoterol)

• Breo Ellipta (fluticasone/vilanterol)

• Symbicort (budesonide/formoterol)

What are bronchodilators?

People who need help getting air through the lungs may be prescribed a bronchodilator, such as those with a respiratory condition like asthma or COPD. Bronchodilators relax smooth muscle in the airways, helping to open up the airways. There are various types of bronchodilators (see below). Bronchodilators do not contain a steroid but are frequently prescribed in combination with one (as separate or combination products). 

How do bronchodilators work?

Bronchodilators known as beta-2 agonists target the beta-2 receptors in the airways of the lungs. They activate the beta-2 receptor, relaxing the smooth muscles of the airways, which helps to improve airflow. These types of bronchodilators are known as SABAs (short-acting beta-agonists) or LABAs (long-acting beta-agonists). 

Other bronchodilators are classified as anticholinergics. Anticholinergics target receptors in the airways called parasympathetic nervous system receptors, blocking a chemical called acetylcholine, which helps to open up the lungs, making it easier to breathe. They also help clear mucus from the lungs.

Theophylline relaxes and opens airways in the lungs, making it easier to breathe. 

What are bronchodilators used for?

Here is a general list of conditions bronchodilators treat or prevent: 

• Asthma

• Chronic lung diseases

  • COPD (chronic obstructive pulmonary disease)

  • Emphysema

  • Bronchitis

Bronchodilators can also be used in lung function assessment tests.

Types of bronchodilators 

Inhaled medications may be delivered in various ways:

• Metered-dose inhaler: The inhaler pushes out the medication with a chemical propellant.

• Nebulizer: This machine delivers the medication in a fine mist through a tube and mask that goes over the nose and mouth.

• Dry powder inhaler: The medication is delivered without chemical propellants, but with a strong, fast inhalation.

Bronchodilators are classified as described below:

Short-acting beta-agonists (SABAs)

Short-acting beta-agonists (SABAs) are used as “rescue” medication because they provide quick relief by rapidly opening up the airways to relieve asthma symptoms. For example, you would use your rescue inhaler when you are having an asthma attack. People with exercise-induced asthma also use SABAs, before exercising. SABAs work quickly. They start working within 15-20 minutes, and their effects last up to four to six hours. 

SABAs include albuterol—found in various forms including inhalers, solutions for the nebulizer, oral solution, and tablets, and across multiple brand-name products such as ProAir HFA, Proventil HFA, and Ventolin HFA—and levalbuterol—found in inhalers and solutions for the nebulizer, and as the brand name Xopenex. 

Albuterol’s recommended generic name by the World Health Organization (WHO) is salbutamol sulfate, but we know the medicine as albuterol in the US. 

If you are using your SABA more than twice weekly, consult your healthcare professional for medical advice. You may need a dosage adjustment in the medications used for long-term control. 

Long-acting beta-agonists (LABAs)

Long-acting beta-agonists (LABAs) keep airways open for about 12 hours and help control symptoms. Serevent is an inhaler that contains the LABA salmeterol. A LABA must always be prescribed with an inhaled corticosteroid (anti-inflammatory), either as two separate products or as a combination product containing a LABA plus an inhaled steroid. This is because a LABA alone, without a steroid, can increase the risk of asthma-related death. Examples of popular combination medications that contain a LABA plus a steroid include Advair, Breo, and Dulera.

Anticholinergics

Anticholinergic bronchodilators include Atrovent HFA (short-acting) and Spiriva (long-acting). They are sometimes referred to as antimuscarinic agents. They work on the smooth muscles in the airways. They block a chemical called acetylcholine. Anticholinergics open the lungs, making it easier to breathe.

Theophylline

Theophylline is a bronchodilator. Theophylline is used to treat chronic asthma or other chronic lung conditions like emphysema or bronchitis. The way it works is not entirely understood, but it is thought to relax and dilate smooth muscles and suppress the airway’s response to stimuli.  

Who can take bronchodilators?

In appropriate candidates, a bronchodilator can be a safe and effective treatment. Before taking a bronchodilator, tell your doctor about your medical conditions and history and any medications you take, including prescription drugs, OTC medicines, and vitamins or supplements. Having an accurate and complete medical history will ensure that your provider can make the best treatment decision for you. 

Can men use bronchodilators?

Men can take bronchodilators, provided they are not allergic and do not fall into one of the restricted categories below. 

Can women use bronchodilators?

Like men, women can take bronchodilators if they are not allergic and not in a restricted category (see below). Women who are pregnant, planning to become pregnant, or breastfeeding, should consult their healthcare provider before using a bronchodilator.

Can children use bronchodilators?

Children can use certain bronchodilators recommended by their healthcare providers. The choice of bronchodilator depends on symptoms as well as age. For example, ProAir HFA (albuterol) has not been studied in children under four years of age, but albuterol solution for the nebulizer is indicated for children ages two years and older. Your pediatrician can advise on the appropriateness and dosing of bronchodilators in children based on their age, symptoms, and medical conditions.

Can seniors use bronchodilators?

Dosing for older adults should start at the low end of the dosing range. This cautious dosing is due to the higher frequency of reduced liver, kidney, or heart function and other medical conditions and potential drug interactions that could occur in this age group. Anticholinergic bronchodilators can potentially cause delirium in older adults.

Are bronchodilators safe?

Bronchodilator recalls

No recalls found.

Bronchodilators restrictions

People with a known allergy or hypersensitivity to a specific bronchodilator, or another ingredient in the drug, should not take it. Certain dry powder inhalers should not be used in people with hypersensitivity to milk protein; some examples include Advair Diskus and Breo Ellipta.

Other general restrictions follow. Check with your healthcare provider before taking a bronchodilator because certain bronchodilators have different warnings. Tell your doctor about all the medical conditions you have and all of the medications you take, including prescription drugs, OTC medicines, and vitamins or supplements. 

Bronchodilators should be used with caution in people with/who are:

• Ischemic heart disease (coronary heart disease) or other heart problems

• High blood pressure

• Arrhythmias (irregular heartbeat)

• Low potassium levels

• Older adults

• Kidney problems

• Diabetes mellitus

• Seizure disorder

• Hyperthyroidism

• Undergoing labor and delivery

As mentioned above, LABAs must be used in combination with an inhaled steroid medication. LABA medications have a black box warning, which is the strongest warning required by the FDA. The warning states that used alone, a LABA increases the risk of asthma-related death. The use of a LABA without an inhaled steroid is contraindicated. This means you cannot take a LABA unless you also take a steroid. 

In children and adolescents, using a LABA alone increases the risk of asthma-related hospitalizations. A LABA must be used with a steroid in patients of any age. A LABA and steroid can be prescribed separately if adherence to the regimen is assured. Otherwise, a combination product that contains both a LABA and a steroid (such as Advair) must be prescribed.

Anticholinergic bronchodilators, in addition to the warnings above, should also be used with caution in people with:

• Angle-closure glaucoma

• Urinary, prostate, or bladder problems

Can you use bronchodilators while pregnant or breastfeeding?

Bronchodilators come in various formulations, and each product has warnings on pregnancy and breastfeeding. Before using a bronchodilator, let your doctor know if you are pregnant, planning to become pregnant, or breastfeeding. Your doctor can consider your symptoms, medical conditions, and medical history to determine if a bronchodilator is safe for you during pregnancy or breastfeeding. 

Are bronchodilators controlled substances?

No, bronchodilators are not controlled substances.

Common bronchodilators side effects

As with any medication, bronchodilators have side effects. Side effects vary based on the type of bronchodilator. 

The most common adverse effects of SABA and LABA bronchodilators include:

• Tremors 

• Nervousness 

• Headache 

• Palpitations 

• Muscle cramps

• Sore throat

Serious side effects are less common. Serious side effects of SABA and LABA bronchodilators may include:

• Paradoxical bronchospasm (sudden airway constriction)

• Low potassium levels

• Myocardial infarction

The most common side effects of anticholinergic bronchodilators include:

• Dry mouth

• Urinary retention (difficulty urinating)

• Fast heart rate

• Constipation 

• Upset stomach

Allergic reactions to bronchodilators are rare. If you are taking a bronchodilator medication and you have hives, difficulty breathing, dizziness, or swelling of the face, tongue, or throat, get emergency medical treatment right away.

This is not a full list of side effects. Other side effects may occur. Ask your doctor about what side effects you can expect and how to address them. If you have bothersome side effects, feel worse, or have other concerns, consult your healthcare provider for medical advice. 

How much do bronchodilators cost?

The price for your bronchodilator prescription will depend on the dosage form, strength, and quantity. Choosing the generic alternative, when available, can save a great deal of money. SingleCare customers find that they save up to 80% on prescription drug prices. SingleCare cards and coupons are free and easy to use. You can use them on your first prescription and subsequent refills.