Beta2-Agonists for Chronic Obstructive Pulmonary Disease (COPD)
|Generic Name||Brand Name|
|albuterol (short-acting)||Proventil, Ventolin|
|formoterol (long-acting)||Foradil, Perforomist|
Long-acting beta2-agonist and corticosteroid combination
|Generic Name||Brand Name|
|formoterol and budesonide||Symbicort|
|salmeterol and fluticasone||Advair|
Short-acting beta2-agonist and anticholinergic combination
|Generic Name||Brand Name|
|albuterol and ipratropium||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 two 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.
Arformoterol, formoterol, or salmeterol may be taken to prevent shortness of breath or coughing that may keep you from exercising.
How Well It Works
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, 3
- Inhaled long-acting beta2-agonists improve lung function and improve symptoms such as shortness of breath.3
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.3
- 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.4, 5 The combination also resulted in fewer COPD exacerbations compared with placebo, but it increased the risk of pneumonia.4
Combining medicines also may reduce the risk of side effects compared to increasing the dose of one medicine.6
All medicines have side effects. But many people don't feel the side effects, or they are able to deal with them. Ask your pharmacist about the side effects of each medicine you take. Side effects are also listed in the information that comes with your medicine.
Here are some important things to think about:
- Usually the benefits of the medicine are more important than any minor side effects.
- Side effects may go away after you take the medicine for a while.
- If side effects still bother you and you wonder if you should keep taking the medicine, call your doctor. He or she may be able to lower your dose or change your medicine. Do not suddenly quit taking your medicine unless your doctor tells you to.
Call your doctor right away if:
- Your wheezing gets worse after taking one of these medicines.
Common side effects of these medicines include:
- Muscle tremors.
- Increased or irregular heartbeat (palpitations).
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.
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 typically 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.
Medicine is one of the many tools your doctor has to treat a health problem. Taking medicine as your doctor suggests will improve your health and may prevent future problems. If you don't take your medicines properly, you may be putting your health (and perhaps your life) at risk.
There are many reasons why people have trouble taking their medicine. But in most cases, there is something you can do. For suggestions on how to work around common problems, see the topic Taking Medicines as Prescribed.
Advice for women
If you are pregnant, breast-feeding, or planning to get pregnant, do not use any medicines unless your doctor tells you to. Some medicines can harm your baby. This includes prescription and over-the-counter medicines, vitamins, herbs, and supplements. And make sure that all your doctors know that you are pregnant, breast-feeding, or planning to get pregnant.
Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.
- Celli BR, et al. (2008). Effect of pharmacotherapy on rate of decline of lung function in chronic obstructive pulmonary disease: Results from the TORCH study. American Journal of Respiratory and Critical Care Medicine, 178(4): 332–338.
- Stoller JK (2002). Acute exacerbations of chronic obstructive pulmonary disease. New England Journal of Medicine, 346(13): 987–994.
- McIvor RA, et al. (2011). COPD, search date April 2010. Online version of BMJ Clinical Evidence: http://www.clinical evidence.com.
- Calverley PM, et al. (2007). Salmeterol and fluticasone propionate and survival in chronic obstructive pulmonary disease. New England Journal of Medicine, 356(8): 775–789.
- Hanania NA, et al. (2003). The efficacy and safety of fluticasone propionate (250 micrograms)/salmeterol (50 micrograms) combined in the Diskus Inhaler for the treatment of COPD. Chest, 124: 834–843.
- Global Initiative for Chronic Obstructive Lung Disease (2011). Global Strategy for the Diagnosis, Management, and Prevention of COPD. Available online: http://www.goldcopd.org/uploads/users/files/GOLD_Report_2011_Feb21.pdf.
Last Revised: February 19, 2013
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