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Inhaled Beta Adrenergic AgonistAka: Inhaled Beta Agonist, Inhaled Terbutaline, Brethaire, Pirbuterol, Maxair, Levalbuterol, Xopenex, Short-acting Beta Agonist, Bronchodilator, Albuterol, Ventolin, Proventil
- See Also
- Long Acting Beta Agonist
- Nebulized Albuterol
- Indications
- Short acting agents for rescue use only
- Adverse Effects: Scheduled short acting MDI use
- Loss of indicator for worsening Asthma
- Delays use of Inhaled Corticosteroid
- Increases airway hyper-reactivity
- Greater allergen exposure
- Treats only acute phase reaction
- Regular use associated with increased mortality
- Terbutaline may be more risk than other preparations
- Acute Coronary Syndrome risk in those with CAD risk
- Au (2002) Chest 121:846
- Monitoring Use
- Most Metered Dose Inhalers supply 120 two spray doses
- Four times daily dosing will last one month
- In well controlled Asthma, inhaler will last one year
- Efficacy
- Albuterol HFA is at least as effective as CFC
- HFA replaces CFC inhalers due to ozone depletion
- Less force and smaller plume than CFC inhaler
- However small particle allows 2-3x lung deposition
- Less coordination needed in HFA firing and inhaling
- Spacer devices should still be used with HFA inhalers
- Albuterol MDI as effective as Nebulizer in ER and home
- Used with spacer (and mask in younger children)
- See Spacer Devices for Asthma Inhalers
- Albuterol MDI has significant advantages over Nebulizer
- No special equipment or maintenance
- Uses only 10% of the amount albuterol nebulized
- Minimal risk of contamination
- References
- Delgado (2003) Arch Pediatr Adolesc Med 157:76
- Mandelberg (1997) Chest 112:1501
- Newman (2002) Chest 121:1036
- Preparations: Short Acting
- Terbutaline (Brethaire)
- Cost: $14.68 per 30 days
- Dose: 2 puffs q4-6 hours
- Not as potently dosed as others
- Use for patients sensitive to adrenergic effects
- Pirbuterol (Maxair)
- Cost: $19.53 per 30 days
- Dose: 2 puffs q4-6 hours
- Albuterol (Ventolin, Proventil)
- Cost: Expensive - no generic HFA inhalers
- Dose
- Standard: 2 puffs q4-6 hours
- Severe COPD exacerbation: 6-8 puffs q1-2 hour (max)
- Levalbuterol (Xoponex): Active R-isomer of albuterol
- Cost: $50 per month
- Dose: 2 puffs up to every 4-6 hours
- Benefit
- No benefit over albuterol in most patients
- Less FEV1 decline with chronic use than albuterol
- Hilaire (2007) Am fam Physician 75:247
- Isoproterenol
- Dose: 2 puffs q3-4 hours
- Isoetharine
- Dose: 2 puffs q4 hours
- Metaproterenol
- Dose: 2 puffs q4-6 hours
- Bitolterol
- Dose: 2 puffs q4-6 hours
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| Definition (MSH) | A racemic mixture with a 1:1 ratio of the r-isomer, levalbuterol, and s-albuterol. It is a short-acting beta2-adrenergic agonist with its main clinical use in ASTHMA. |
| Definition (CSP) | short-acting beta2-adrenergic agonist with its main clinical use in asthma. |
| Definition (NCI) | A racemic mixture of the r-isomer levalbuterol and s-albuterol, a short-acting sympathomimetic agent with bronchodilator activity. Albuterol stimulates beta2-adrenergic receptors in the lungs, thereby activating the enzyme adenylate cyclase that catalyzes the conversion of adenosine triphosphate (ATP) to cyclic-3',5'-adenosine monophosphate (cAMP). Increased cAMP concentrations relax bronchial smooth muscle, relieve bronchospasms, and reduce inflammatory cell mediator release, especially from mast cells. Albuterol although to a lesser extent, also stimulates beta1-adrenergic receptors, thereby increasing the force and rate of myocardial contraction. |
| Concepts | Organic Chemical (T109)
, Pharmacologic Substance (T121)
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| English | Albuterol, ALBUTEROL PREPARATION, Salbutamol, Salbutamol product |
| Spanish | albuterol, salbutamol |
| Credits | Derived from the NIH UMLS (Unified Medical Language System)
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Bronchodilator Agents (C0006280)
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| Definition (MSH) | Agents that cause an increase in the expansion of a bronchus or bronchial tubes. |
| Definition (CSP) | agent that causes an expansion of the lumen of a bronchus or bronchiole. |
| Concepts | Pharmacologic Substance (T121)
|
| English | Bronchial Dilating Agents, bronchodilator, Bronchodilator Agents, Bronchodilator preparations, Bronchodilators, lumen dilator |
| Spanish | agentes broncodilatadores, broncodilatador, preparaciones con broncodilatadores |
| Credits | Derived from the NIH UMLS (Unified Medical Language System)
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| Definition (NCI) | A short-acting, beta-adrenergic receptor agonist with bronchodilator activity. Pirbuterol selectively binds to beta-2 adrenergic receptors in bronchial smooth muscle, thereby activating intracellular adenyl cyclase, an enzyme that catalyzes the conversion of adenosine triphosphate (ATP) to cyclic-3',5'-adenosine monophosphate (cAMP). Increased cAMP levels cause relaxation of bronchial smooth muscle, relieve bronchospasms, improve mucociliary clearance and inhibit the release of mediators of immediate hypersensitivity from cells, especially from mast cells. |
| Concepts | Organic Chemical (T109)
, Pharmacologic Substance (T121)
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| English | pirbuterol, PIRBUTEROL PREPARATION, pyrbuterol |
| Spanish | pirbuterol |
| Credits | Derived from the NIH UMLS (Unified Medical Language System)
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| Definition (MSH) | The R-isomer of albuterol. |
| Concepts | Organic Chemical (T109)
, Pharmacologic Substance (T121)
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| English | Levalbuterol, LEVALBUTEROL PREPARATION |
| Spanish | levalbuterol |
| Credits | Derived from the NIH UMLS (Unified Medical Language System)
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