Chronic Obstructive Pulmonary Disease (COPD) (cont.)
George Schiffman, MD, FCCP
Dr. Schiffman received his B.S. degree with High Honors in biology from Hobart College in 1976. He then moved to Chicago where he studied biochemistry at the University of Illinois, Chicago Circle. He attended Rush Medical College where he received his M.D. degree in 1982 and was elected to the Alpha Omega Alpha Medical Honor Society. He completed his Internal Medicine internship and residency at the University of California, Irvine.
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
In this Article
- Chronic obstructive pulmonary disease facts
- What is COPD?
- How does the normal lung work?
- What is chronic bronchitis?
- What is emphysema?
- What is chronic asthma?
- What is bronchiectasis?
- What causes COPD?
- What are the symptoms of COPD?
- How is COPD diagnosed?
- What treatment is available for COPD?
- Quitting cigarette smoking
- COPD Medications
- Bronchodilators
- Beta-agonists
- Anti-cholinergic agents
- Methylxanthines
- Corticosteroids
- Breo Ellipta
- Treatment of Alpha-1 antitrypsin deficiency
- What is the role of oxygen as therapy in COPD?
- What else is available for treating COPD?
- Future directions in COPD
- COPD (Chronic Obstructive Pulmonary Disease) FAQs
- Find a local Pulmonologist in your town
Beta-agonists
Historically, one of the first medications used for asthma was adrenaline (epinephrine). Adrenaline has a rapid onset of action in opening the airways. It is still used in certain emergency situations for attacks of asthma. Unfortunately, adrenaline has many side effects including rapid heart rate, headache, nausea, vomiting, restlessness, and a sense of panic. Therefore, it is not used in the treatment of COPD.
Beta-2 agonists have the bronchodilating effects of adrenaline without many of its unwanted side effects. Beta-2 agonists can be administered by MDI inhalers or orally. They are called "agonists" because they activate the beta-2 receptor on the muscles surrounding the airways. Activation of beta-2 receptors relaxes the muscles surrounding the airways and opens the airways. Dilating airways helps to relieve the symptoms of dyspnea (shortness of breath). Beta-2 agonists have been shown to relieve dyspnea in many COPD patients, even among those without demonstrable reversibility in airway obstruction. The action of beta-2 agonists starts within minutes after inhalation and lasts for about 4 hours. Because of their quick onset of action, beta-2 agonists are especially helpful for patients who are acutely short of breath.
Because of their short duration of action, these medications should be used for symptoms as they develop rather than as maintenance. Evidence suggests that when these drugs are used routinely, their effectiveness is diminished. These are referred to as rescue inhalers.
Examples of beta-2 agonists include albuterol (Ventolin HFA, Proventil HFA, Proair), metaproterenol (Alupent), pirbuterol (Maxair), terbutaline (Brethaire), isoetharine (Bronkosol), and levalbuterol (Xopenex). Albuterol is a chemical that comes mixed in two forms, mirror images of itself, a left and right hand. Levalbuterol is a purer form of albuterol, the left hand component. There are some theoretical advantages to this form including possibly reduced side effects.
Side effects of beta-2 agonists include anxiety, tremor, palpitations or fast heart rate, and low blood potassium (hypokalemia).
Next: Anti-cholinergic agents
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