Short-acting Beta Agonist

Aka: Short-acting Beta Agonist, SABA, Inhaled Beta Adrenergic Agonist, Inhaled Beta Agonist, Inhaled Bronchodilator, Bronchodilator, Proventil, Inhaled Terbutaline, Brethaire, Pirbuterol, Maxair

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II. Indications

  1. Short acting Bronchodilator agents for rescue use only

III. Mechanism

  1. Inhaled Bronchodilators target Beta 2 Adrenergic Receptors on Bronchial Smooth Muscle
    1. Increase cAMP messenger levels
    2. cAMP relaxes Bronchial Smooth Muscles resulting in bronchodilation
  2. Adverse effects (e.g. Tachycardia) are related to Beta 1 Adrenergic Receptor activity

IV. Medications: Short Acting Bronchodilators - Common Use

  1. Albuterol Inhaler (Ventolin, Proventil, ProAir HFA, ProAir RespiClick)
    1. See Hydrofluoroalkane Inhaler (HFA Inhaler) for technique
    2. Rescue Inhaler: 2 puffs every 4 to 6 hours as needed
    3. Exercise Induced Asthma: 2 puffs used 10 to 30 minutes before Exercise
    4. Severe COPD or Asthma Exacerbation
      1. Use 6 to 8 puffs every 1-2 hours (max) OR
      2. Use 2 puffs every 20 minutes as needed for up to 3 doses every 1 to 4 hours
  2. Albuterol Nebulizer
    1. Dilute Albuterol solution (5 mg/ml) in Normal Saline (NS) as described above
    2. Weight <10 kg or age under 12 months (0.15 mg/kg)
      1. Albuterol 1.25 mg (0.25 cc) in 2 cc NS q1-4 hours
    3. Weight 10-35 kg or age 12 months to adult (Typical, standard dose)
      1. Albuterol 2.5 mg (0.5 cc) in 2 cc NS q1-4 hours
    4. Weight >35 kg or age over 10 years (High Dose)
      1. Albuterol 5.0 mg (1.0 cc) in 2 cc NS q1-4 hours
      2. Standard dose of 2.5 mg is used instead in most cases
    5. Continuous Nebulizer
      1. Dose 10 to 15 mg/hour until improvement (typically first hour)
      2. Intensive monitoring including telemetry within emergency department or ICU
  3. Levalbuterol Inhaler (age 4 years and older)
    1. See Hydrofluoroalkane Inhaler (HFA Inhaler) for technique
    2. Take 2 puffs up to every 4 to 6 hours
    3. Generic in 2016
  4. Levalbuterol (Xopenex) Nebulizer
    1. Indicated for Age over 12 years
    2. Age >=12 years: 0.63 (up to maximum of 1.25 mg) nebulized every 6 to 8 hours as needed
    3. Age 6 to 11 years: 0.31 mg nebulized every 8 hours as needed

V. Medications: Short Acting Bronchodilators - Uncommon Use

  1. Terbutaline (Brethaire)
    1. Dose: 2 puffs q4-6 hours
    2. Not as potently dosed as others
    3. Use for patients sensitive to adrenergic effects
  2. Pirbuterol (Maxair)
    1. Dose: 2 puffs q4-6 hours
  3. Isoproterenol
    1. Dose: 2 puffs q3-4 hours
  4. Isoetharine
    1. Dose: 2 puffs q4 hours
  5. Metaproterenol
    1. Dose: 2 puffs q4-6 hours
  6. Bitolterol
    1. Dose: 2 puffs q4-6 hours

VI. Adverse Effects

  1. Tachycardia
  2. Palpitations
  3. Tremor
  4. Anxiousness
  5. Headache
  6. Nausea
  7. Transient Hypokalemia
  8. Tachyphylaxis (see precautions below)

VII. Precautions

  1. Avoid Scheduled short acting MDI use
    1. Loss of indicator for worsening Asthma
    2. Delays use of Inhaled Corticosteroid
    3. Increases airway hyper-reactivity
    4. Greater allergen exposure
      1. Treats only acute phase reaction
    5. Regular use associated with increased mortality
      1. Inhaled Terbutaline may be more risk than other preparations
    6. Acute Coronary Syndrome risk in those with CAD risk
      1. Au (2002) Chest 121:846-51 [PubMed]
  2. Monitoring Use
    1. Most Metered Dose Inhalers supply 100-120 two spray doses
    2. Four times daily dosing will last one month
    3. In well controlled Asthma, Inhaler will last one year

VIII. Efficacy

  1. Beta Agonists have reduced activity in severely acidotic or hypoxic patients
  2. Reduced efficacy of Bronchodilators in the 20% of patients with arginine Genotype
    1. Israel (2001) Int Arch Allergy Immunol 124:183-6 [PubMed]
    2. Wechsler (2005) Am J Respir Crit Care Med 172(1):12-8 [PubMed]
  3. References
    1. Delgado (2003) Arch Pediatr Adolesc Med 157:76-80 [PubMed]
    2. Mandelberg (1997) Chest 112:1501-5 [PubMed]
    3. Newman (2002) Chest 121:1036-41 [PubMed]

IX. Drug Interactions

  1. Increased Sympathomimetic effects
    1. MAO Inhibitors
    2. Tricyclic Antidepressants
  2. Decreased beta Agonist effects
    1. Beta Blockers

X. References

  1. Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 88
  2. Hamilton (2020) Tarascon Pocket Pharmacopoeia
  3. (2022) Comparison of Asthma Medications, Presc Lett, #381217
  4. (2022) Inhaled Medications for COPD, Presc Lett, #381116
  5. (2020) Drugs for COPD, Med Lett Drug Ther 62: 137-44
  6. (2020) Drugs for Asthma, Med Lett Drug Ther 62: 193-200

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Cost: Medications

proventil (on 5/18/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
PROVENTIL HFA 90 MCG INHALER Generic $3.23 per gram
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information. GoodRx is another tool for finding lower drug prices.

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