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Bronchodilator Therapy for Asthma

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Allergy and Asthma

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Abstract

Bronchodilators are essential medications used in the management of asthma. As reversible airway obstruction is a cardinal feature of asthma, bronchodilators play an essential role in reversing airway obstruction and provide “bronchoprotection” against bronchospasm due to exercise and other spasmogenic stimuli. In addition to acting as rescue agents in the treatment of bronchospasm, some bronchodilators, such as long-acting beta-agonists (LABAs) and long-acting anti-muscarinic agents (LAMAs), are used as controller agents when used in combination with inhaled glucocorticoid (GC) therapy. This chapter will provide a comprehensive overview of the three major classes of bronchodilators, beta-adrenergic agonists (β-agonists), anticholinergic agents, and theophylline, followed by a brief discussion of phosphodiesterase inhibitors.

β-Agonists are the most important class of bronchodilators. Short-acting beta-agonists (SABAs) are the most effective medications available in relieving bronchospasm and preventing exercise-induced bronchospasm. LABAs, when used in fixed combination with inhaled GCs, are very effective in improving asthma control and are the preferred controller agents for asthmatics with moderate-to-severe persistent asthma. The anticholinergic ipratropium when used in combination with albuterol in the ED can reduce the number of asthma exacerbations requiring hospitalization. It is less effective than albuterol in relieving bronchospasm in asthma while being as effective as albuterol in patients with chronic obstructive lung disease (COPD). Tiotropium, a LAMA, is now indicated as an add-on agent in patients with asthma inadequately controlled on an inhaled GC alone or in combination with a LABA. Theophylline, although widely used in the past century, is rarely prescribed due to its narrow therapeutic window and the availability of much more effective agents, such as LABAs and inhaled GCs. Phosphodiesterase inhibitors have the potential to be the very effective asthma medications, but problems with toxicity have limited their use.

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Authors and Affiliations

  1. Department of Pediatrics, Division of Allergy/Immunology, University of Colorado Medical School, Aurora, CO, USA

    Joseph D. Spahn

  2. Children’s Hospital Colorado, Aurora, CO, USA

    Ryan Israelsen

  3. Allergy and Asthma Center of Southern Oregon/Clinical Research Institute of Southern Oregon, Medford, OR, USA

    Ryan Israelsen

Authors
  1. Joseph D. Spahn
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  2. Ryan Israelsen
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Corresponding author

Correspondence to Joseph D. Spahn .

Section Editor information

  1. Division of Allergy & Immunology, University of South Florida, Tampa, FL, USA

    Dennis K. Ledford

  2. Milton S Hershey Med Ctr, Penn State University, Hershey, PA, USA

    Timothy Craig

  3. Division of General Medicine/Department of Medicine, University of California, San Francisco, CA, USA

    Massoud Mahmoudi

  4. Department of Medicine and Pediatrics, Penn State College of Medicine, Hershey, PA, USA

    Timothy Craig

  5. Division of Allergy & Immunology, Dept. of Internal Medicine, University of South Florida Morsani College of Medicine, James A Haley Veterans' Hospital, Asthma and Immunology Associates of Tampa Bay, Tampa, Florida, USA

    Dennis K. Ledford

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Spahn, J.D., Israelsen, R. (2019). Bronchodilator Therapy for Asthma. In: Allergy and Asthma. Springer, Cham. https://doi.org/10.1007/978-3-030-05147-1_38

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  • DOI: https://doi.org/10.1007/978-3-030-05147-1_38

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