II. Indications
- Short acting agents for rescue use only
III. Mechanism
- Inhaled Bronchodilators target Beta 2 Adrenergic Receptors
- Adverse effects (e.g. Tachycardia) are related to Beta 1 Adrenergic Receptor activity
IV. 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
V. Management: Monitoring Use
- Most Metered Dose Inhalers supply 100-120 two spray doses
- Four times daily dosing will last one month
- In well controlled Asthma, Inhaler will last one year
VI. Efficacy
- Albuterol HFA is at least as effective as CFC
- 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
- Reduced efficacy of Bronchodilators in the 20% of patients with arginine Genotype
- References
VII. Technique: Hydrofluoroalkane Inhaler (HFA Inhaler)
- Prior to first use
- Later uses
- Other pointers
- Do not use "float test" (placing Inhaler in water) to see if has any medicine remaining
- Tally on the package the number of 2-puff doses used (expect about 100, 2-puff doses)
VIII. 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)
- Maxair Autohaler will be only CFC Inhaler on U.S. market
- Cost: $19.53 per 30 days
- Dose: 2 puffs q4-6 hours
- Albuterol (Ventolin, Proventil, ProAir HFA, ProAir RespiClick)
- Preparations
- ProAir HFA Inhalers
- ProAir RespiClick (Dry Powder Inhaler, released 2015)
- Requires deep inhalation, but no spacer needed
- Approved age 12 years and older
- Cost
- Dose
- Standard: 2 puffs q4-6 hours
- Severe COPD exacerbation: 6-8 puffs q1-2 hour (max)
- Preparations
- Levalbuterol (Xoponex): Active R-isomer of Albuterol
- Cost: Originally $50 per month (now generic as of 2016)
- 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 75:247-8 [PubMed]
- No benefit over Albuterol in most patients
-
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
Images: Related links to external sites (from Bing)
Related Studies
Albuterol (on 6/18/2017 at Walmart.com) | ||
Albuterol 2mg | #90 tablets for $4.00 | $0.04 each |
Albuterol 2mg | #270 tablets for $10.00 | $0.04 each |
Albuterol 2mg/5ml syrup | #120 ml for $4.00 | $0.03 each |
Albuterol 2mg/5ml syrup | #360 ml for $10.00 | $0.03 each |
Albuterol 4mg | #60 tablets for $4.00 | $0.07 each |
Albuterol 4mg | #180 tablets for $10.00 | $0.06 each |
albuterol (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
ALBUTEROL 2.5 MG/0.5 ML SOL | Generic | $0.35 each |
ALBUTEROL 5 MG/ML SOLUTION | Generic | $1.33 per ml |
ALBUTEROL SUL 0.63 MG/3 ML SOL | Generic | $0.27 per ml |
ALBUTEROL SUL 1.25 MG/3 ML SOL | Generic | $0.24 per ml |
ALBUTEROL SUL 2.5 MG/3 ML SOLN | Generic | $0.04 per ml |
ALBUTEROL SULF 2 MG/5 ML SYRUP | Generic | $0.03 per ml |
ALBUTEROL SULFATE 2 MG TAB | Generic | $3.94 each |
ALBUTEROL SULFATE 4 MG TAB | Generic | $3.52 each |
ALBUTEROL SULFATE ER 4 MG TAB | Generic | $1.32 each |
ALBUTEROL SULFATE ER 8 MG TAB | Generic | $2.23 each |
ventolin (on 2/22/2017 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
VENTOLIN HFA 90 MCG INHALER | $2.79 per gram | |
proventil (on 2/22/2017 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
PROVENTIL HFA 90 MCG INHALER | $10.80 per gram | |
levalbuterol (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
LEVALBUTEROL 0.31 MG/3 ML SOL | Generic | $0.52 per ml |
LEVALBUTEROL 0.63 MG/3 ML SOL | Generic | $0.51 per ml |
LEVALBUTEROL 1.25 MG/3 ML SOL | Generic | $0.49 per ml |
LEVALBUTEROL TAR HFA 45 MCG INH | Generic | $3.76 per gram |
xopenex (on 2/28/2017 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
XOPENEX 1.25 MG/3 ML SOLUTION | Generic | $0.49 per ml |
XOPENEX HFA 45 MCG INHALER | Generic | $3.76 per gram |
Ontology: Adrenergic beta-Agonists (C0001644)
Definition (MSH) | Drugs that selectively bind to and activate beta-adrenergic receptors. |
Concepts | Pharmacologic Substance (T121) |
MSH | D000318 |
SnomedCT | 349920008, 373227004 |
English | beta Adrenergic Receptor Agonists, Adrenergic beta Agonist, Adrenergic beta Agonists, Adrenergic beta Receptor Agonist, Adrenergic beta Receptor Agonists, Adrenergic beta-Agonist, Adrenergic beta-Receptor Agonist, Adrenergic beta-Receptor Agonists, Agonist, Adrenergic beta-Receptor, Agonist, beta-Adrenergic, Agonist, beta-Adrenergic Receptor, Agonists, Adrenergic beta-Receptor, Agonists, beta-Adrenergic, Agonists, beta-Adrenergic Receptor, Receptor Agonist, beta-Adrenergic, Receptor Agonists, beta Adrenergic, Receptor Agonists, beta-Adrenergic, Receptors Agonists, Adrenergic beta, beta Adrenergic Agonist, beta Adrenergic Agonists, beta Adrenergic Receptor Agonist, beta-Adrenergic Agonist, beta-Adrenergic Receptor Agonist, beta-Adrenergic Receptor Agonists, beta-Agonist, Adrenergic, beta-Agonists, Adrenergic, beta-Receptor Agonist, Adrenergic, beta-Receptor Agonists, Adrenergic, Beta-Adrenergic Agonist, ADREN BETA AG, ADREN BETA RECEPT AGON, BETA ADREN AG, BETA ADREN AGON, ADREN BETA RECEPT AG, RECEPT AGON BETA ADREN, RECEPT AGON ADREN BETA, BETA ADREN RECEPT AG, ADRENERGIC RECEPTOR AGONISTS BETA, ADRENERGIC AGONISTS BETA, ADREN BETA AGON, BETA ADREN RECEPT AGON, beta-Adrenergic Agonists, Betamimetics, antiadrenergic beta receptor agents (medication), antiadrenergic beta receptor agents, adrenergic beta receptor agonists, Adrenergic beta-Agonists, beta-adrenergic receptor agonists, beta adrenergic agonist, beta-adrenergic agonist, beta-adrenergic agonists, agonists beta adrenergic receptor, beta adrenergic agonists, Adrenergic beta agonists, Beta-adrenoceptor agonist, Beta-adrenoceptor agonist (product), Beta-adrenoceptor agonist (substance), Beta-adrenergic Agonists |
Swedish | Adrenerga betastimulerare |
Czech | receptory adrenergní beta - agonisté |
Portuguese | Agonistas beta-Adrenérgicos, Agonistas dos Receptores Adrenérgicos beta, Agonistas Adrenérgicos beta, beta-Agonistas Adrenérgicos, Agonistas dos Receptores beta-Adrenérgicos, Agonistas dos beta-Receptores Adrenérgicos |
Finnish | Beeta-agonistit |
French | Agonistes beta-adrénergiques, Agonistes des adrénorécepteurs bêta, Bêta-adrénergiques, Bêta-stimulants, Sympathomimétiques bêta, Agoniste bêta-adrénergique, Agonistes bêta-adrénergiques, Agonistes des récepteurs bêta-adrénergiques, Bêta-mimétiques |
Russian | ADRENERGICHESKIE BETA-AGONISTY, ADRENORETSEPTOROV-BETA AGONISTY, BETA-ADRENORETSEPTOROV AGONISTY, ADRENERGICHESKIKH BETA-RETSEPTOROV AGONISTY, АДРЕНЕРГИЧЕСКИЕ БЕТА-АГОНИСТЫ, АДРЕНЕРГИЧЕСКИХ БЕТА-РЕЦЕПТОРОВ АГОНИСТЫ, АДРЕНОРЕЦЕПТОРОВ-БЕТА АГОНИСТЫ, БЕТА-АДРЕНОРЕЦЕПТОРОВ АГОНИСТЫ |
Spanish | Agonistas beta-Adrenérgicos, Agonistas de los beta-Receptores Adrenérgicos, Agonistas Adrenérgicos beta, Agonistas de los Receptores Adrenérgicos beta, Agonistas de los Receptores beta-Adrenérgicos, beta-Agonistas Adrenérgicos, agonista beta adrenérgico (producto), agonista beta adrenérgico (sustancia), agonista beta adrenérgico, agonista betadrenérgico (sustancia), agonista betadrenérgico |
German | ADRENERGE AGONISTEN BETA, Adrenerge Beta-Agonisten, Beta-Adrenomimetika, Beta-Rezeptorenagonisten |
Polish | Agoniści adrenergiczni beta, Beta-mimetyki, Agoniści receptora adrenergicznego beta |
Japanese | β-アドレナリン作動性受容体作用薬, β-作動剤, β-作動薬, β-作用薬, β-刺激薬, β-受容体作用薬, アドレナリンベータアゴニスト, アドレナリン作用性ベータ受容体作用薬, ベータアドレナリン作用性受容体作用薬, β作動薬, β刺激剤, β刺激薬, β受容体刺激薬, アドレナリン作用性ベータ受容体作用剤, アドレナリン作用性ベータ受容体作用物質, アドレナリン作用性ベータ受容器作用物質 |
Italian | Beta-agonisti adrenergici |
Ontology: Albuterol (C0001927)
Definition (MSH) | A short-acting beta-2 adrenergic agonist that is primarily used as a bronchodilator agent to treat ASTHMA. Albuterol is prepared as a racemic mixture of R(-) and S(+) stereoisomers. The stereospecific preparation of R(-) isomer of albuterol is referred to as levalbuterol. |
Definition (CHV) | asthma inhaler |
Definition (CHV) | asthma inhaler |
Definition (NCI) | A racemic mixture of the r-isomer levalbuterol and s-albuterol, a short-acting sympathomimetic agent with bronchodilator activity. Albuterol stimulates beta-2 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 beta-1 adrenergic receptors, thereby increasing the force and rate of myocardial contraction. |
Definition (CSP) | short-acting beta2-adrenergic agonist with its main clinical use in asthma. |
Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
MSH | D000420 |
SnomedCT | 326162005, 134493007, 372897005, 91143003 |
LNC | LP17843-1, MTHU013596 |
English | Albuterol, 1,3-Benzenedimethanol, alpha1-(((1,1-dimethylethyl)amino)methyl)-4-hydroxy-, 2-t-Butylamino-1-(4-hydroxy-3-hydroxy-3-hydroxymethyl)phenylethanol, Salbutamol [obstetric], albuterol, albuterol (medication), Albuterol [Chemical/Ingredient], salbutamol, Salbutamol [inhalation preparations 2] (product), Salbutamol [inhalation preparations 2], Salbutamol [obstetric] (product), ALBUTEROL, Salbutamol product, Albuterol (product), Albuterol (substance), Salbutamol [inhalation preparations 2] (substance), Salbutamol [obstetric] (substance), Salbutamol |
Swedish | Albuterol |
Czech | salbutamol, albuterol |
Finnish | Salbutamoli |
French | Albutérol, Salbutamol, 2-t-Butylamino-1-(4-hydroxy-3-hydroxy-3-hydroxyméthyl)phényléthanol |
Italian | 2-t-Butilamino-1-(4-idrossi-3-idrossi-3-idrossimetil)feniletanolo, Salbutamolo, Albuterolo |
Russian | SAL'BUTAMOL, AL'BUTEROL, АЛЬБУТЕРОЛ, САЛЬБУТАМОЛ |
Japanese | 硫酸サルブタモール, アルブテロール, サルブタモール |
Spanish | albuterol (producto), salbutamol, salbutamol (producto), Salbutamol [inhalation preparations 2], Salbutamol [inhalation preparations 2] (product), salbutamol [obstétrico], salbutamol [preparaciones para inhalación 2], salbutamol [preparaciones para inhalación 2] (producto), salbutamol [obstétrico] (producto), albuterol (sustancia), albuterol, Albuterol, Salbutamol |
Croatian | ALBUTEROL |
Polish | Salbutamol, Albuterol |
German | Albuterol |
Portuguese | Albuterol, Salbutamol |
Ontology: Bronchodilator Agents (C0006280)
Definition (NCI_NCI-GLOSS) | A type of drug that causes small airways in the lungs to open up. Bronchodilators are inhaled and are used to treat breathing disorders, such as asthma or emphysema. |
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) |
MSH | D001993 |
SnomedCT | 116091006, 300900000, 373241008, 353866001, 372580007 |
LNC | LP31460-6 |
English | Agents, Bronchodilator, Bronchodilator Agents, Agents, Bronchial-Dilating, Bronchial Dilating Agents, Bronchial-Dilating Agents, Bronchodilators, lumen dilator, bronchodilators, bronchodilator agents, bronchodilators (medication), bronchodilator, Bronchodilator (product), Bronchodilator agents (substance), Bronchodilator agents, Bronchodilator preparations, Bronchodilator, Bronchodilator (substance), Bronchodilator preparations (product), Bronchodilator preparations (substance) |
French | Agents bronchodilatateurs, Bronchodilatateurs |
Swedish | Bronkvidgande medel |
Czech | bronchodilatancia |
Finnish | Bronkodilataattorit |
Russian | BRONKHORASSHIRIAIUSHCHIE SREDSTVA, БРОНХОРАСШИРЯЮЩИЕ СРЕДСТВА |
Japanese | 気管支拡張剤, 気管支拡張薬 |
Croatian | BRONHODILATORI |
Polish | Leki rozszerzające oskrzela, Środki broncholityczne |
Portuguese | Dilatadores Brônquicos, Efeito Broncodilatador, Agentes Broncodilatadores, Dilatadores Bronquiais, Fármacos Broncodilatadores, Broncodilatadores |
Spanish | Dilatadores Bronquiales, Broncodilatadores, agentes broncodilatadores, broncodilatador (producto), agentes broncodilatadores (sustancia), Agentes Broncodilatadores, Efecto Broncodilatador, Fármacos Broncodilatadores, broncodilatador (sustancia), broncodilatador, preparaciones con broncodilatadores (producto), preparaciones con broncodilatadores (sustancia), preparaciones con broncodilatadores |
German | Bronchienerweiternde Mittel, Bronchodilatatoren |
Italian | Broncodilatatori |
Ontology: Ventolin (C0033744)
Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
MSH | D000420 |
French | Ventoline |
English | ventolin, Ventolin |
Ontology: pirbuterol (C0071129)
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 | Pharmacologic Substance (T121) , Organic Chemical (T109) |
MSH | C009118 |
SnomedCT | 108611006, 372516006 |
English | pirbuterol, pyrbuterol, pirbuterol (medication), pirbuterol [Chemical/Ingredient], PIRBUTEROL, Pirbuterol, Pirbuterol (product), Pirbuterol (substance) |
Spanish | pirbuterol (producto), pirbuterol (sustancia), pirbuterol |
Ontology: Proventil (C0699770)
Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
MSH | D000420 |
French | Proventil |
English | proventil, Proventil |
Ontology: Brethaire (C0701015)
Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
MSH | D013726 |
English | brethaire, AstraZeneca Brand of Terbutaline, Brethaire, Terbutaline AstraZeneca Brand |
Ontology: Maxair (C0721597)
Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
MSH | C009118 |
English | Maxair, 3M brand of pirbuterol acetate, maxair |
Ontology: Levalbuterol (C0772501)
Definition (NCI) | A short-acting sympathomimetic beta-2 adrenergic receptor agonist with bronchodilator activity. Levalbuterol binds to beta-2 adrenergic receptors in bronchial smooth muscle and activates intracellular adenyl cyclase, an enzyme that catalyzes the conversion of adenosine triphosphate (ATP) to cyclic-3',5'-adenosine monophosphate (cAMP). Increased cAMP levels lead to the activation of protein kinase A, which inhibits the phosphorylation of myosin and lowers intracellular ionic calcium concentrations, resulting in relaxation of bronchial smooth muscles. The increased cAMP concentrations also inhibit the release of inflammatory mediators, especially from mast cells. |
Definition (MSH) | The R-isomer of albuterol. |
Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
MSH | D064412 |
SnomedCT | 116090007, 398965008 |
LNC | LP171617-6 |
English | Levalbuterol [Chemical/Ingredient], Levalbuterol, LEVALBUTEROL, levalbuterol, Levalbuterol (product), Levalbuterol (substance) |
Czech | levalbuterol |
French | Levalbutérol, Lévosalbutamol |
German | Levosalbutamol, Levalbuterol |
Italian | Levalbuterolo |
Russian | КСОПЕНЕКС, LEVALBUTEROL, ЛЕВАЛЬБУТЕРОЛ, ЛЕВАЛБУТЕРОЛ, LEVAL'BUTEROL, KSOPENEKS |
Spanish | levalbuterol (producto), levalbuterol (sustancia), levalbuterol, levo-salbutamol |
Ontology: Xopenex (C0876218)
Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
MSH | D064412 |
English | xopenex, Xopenex |
Czech | Xopenex |
French | Xopenex |
German | Xopenex |