Beta2-agonists for chronic obstructive pulmonary disease (COPD)

Examples

Prescription beta2-agonists

Generic Name	Brand Name
albuterol (short-acting)	Proventil, Ventolin HFA
arformoterol tartrate (long-acting)	Brovana
formoterol (long-acting)	Foradil, Perforomist
levalbuterol (short-acting)	Xopenex
metaproterenol sulfate (short-acting)	Alupent
pirbuterol acetate (short-acting)	Maxair
salmeterol xinafoate (long-acting)	Serevent
terbutaline sulfate (short-acting)

Prescription long-acting beta2-agonist and corticosteroid combination

Generic Name	Brand Name
salmeterol xinafoate and fluticasone propionate	Advair Diskus
formoterol and budesonide	Symbicort

Prescription short-acting beta2-agonist and anticholinergic combination

Generic Name	Brand Name
albuterol sulfate and ipratropium bromide	Combivent, DuoNeb

Beta2-agonists are available in metered-dose inhaler (MDI), nebulizer, pill, injected, and syrup forms. Some beta2-agonists may be available in multiple forms. Your doctor will help you decide which form is best for you.

There are 2 types of beta2-agonists: short-acting and long-acting. The short-acting type relieves symptoms and the long-acting type helps prevent breathing problems. Short-acting beta2-agonists are used for treating stable COPD in a person whose symptoms come and go (intermittent symptoms). Long-acting beta2-agonists are effective and convenient for preventing and treating COPD in a person whose symptoms do not go away (persistent symptoms).

How It Works

Beta2-agonists are bronchodilators. This means that they relax and enlarge (dilate) the airways in the lungs, making breathing easier.

Why It Is Used

Beta2-agonists are considered first-line therapy for the treatment of stable chronic obstructive pulmonary disease (COPD) with symptoms that come and go (intermittent symptoms). They are used for both short- and long-term relief of symptoms.

Beta2-agonists also may be used before exercise to reduce breathing difficulties.

Salmeterol, formoterol, or arformoterol may be taken to prevent shortness of breath or coughing that may keep you from exercising.

How Well It Works

Studies indicate that inhaled beta2-agonists are effective in treating symptoms of COPD and improving lung function as measured by tests (spirometry). They also reduce the number of COPD exacerbations. There is no evidence of their effect on the progression of the disease.¹

Compared to placebo:

• Inhaled short-acting beta2-agonists are effective in treating a person whose symptoms are rapidly getting worse (COPD exacerbation) and improving lung function and shortness of breath in stable COPD.^{2, 1}
• Inhaled long-acting beta2-agonists improve lung function and improve symptoms such as shortness of breath.¹

Results vary from one person to the next. For some people with COPD, beta2-agonist medicines make breathing much easier. For others, they do not help.

Combining medicines may help your lung function. Using a beta2-agonist:

• With an anticholinergic may help your lung function more than using either medicine alone.¹
• With an inhaled corticosteroid may result in improved shortness of breath and less use of relief medicine compared to placebo or compared to either medicine used alone.^{3, 4} The combination also resulted in fewer COPD exacerbations compared with placebo, but it increased the risk of pnemonia.³

Combining medicines usually increases your cost but may also reduce the risk of side effects compared to increasing the dose of one medicine.⁵

Side Effects

Side effects are much more likely to occur when you take this medicine as a pill or injection than when you use the inhaled form. Side effects can include:

• Anxiety.
• Muscle tremors.
• Nervousness.
• Increased or irregular heartbeat (palpitations).

The U.S. Food and Drug Administration (FDA) has reported that arformoterol, formoterol, and salmeterol may make breathing more difficult. If your wheezing gets worse after taking these medicines, call your doctor right away.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

While short-acting beta2-agonists may be the first choice for treating symptoms of mild COPD that come and go (intermittent symptoms), anticholinergics generally are regarded as the first-line treatment for persistent symptoms, in most cases of COPD.

Inhalation is the preferred method of taking beta2-agonists. This method reduces the chance of side effects and makes the medicine more effective. Pills and injections are reserved for those who cannot use a metered-dose inhaler (MDI) or nebulizer.

Nebulizers normally are no better at delivering beta2-agonists deep into the lungs than a properly used metered-dose inhaler. Sometimes your doctor may prescribe a nebulizer. Although a nebulizer can deliver a very large dose of medicine, it also may increase side effects of the medicine.

Most doctors recommend that everyone using an inhaler also use a spacer. Use of a spacer is especially important when using an inhaler containing a steroid medicine. But you should not use a dry powder inhaler (DPI) with a spacer.

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Author:	Maria G. Essig, MS, ELS	Last Updated: May 8, 2008
Medical Review:	Caroline S. Rhoads, MD - Internal Medicine Ken Y. Yoneda, MD - Pulmonology
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