What are the short-acting beta-agonists used for asthma & COPD?
Albuterol Terbutaline Metaproterenol Pirbuterol Levalbuterol
What are the long-acting beta-agonists used for asthma & COPD?
Fomoterol
Salmeterol
Indacaterol/Vilanterol
Olodaterol
How beta agonists work?
They work on Gs protein receptors –> increase of AC –> increased cAMP –> bronchodilation
Albuterol
- SABA
- Indications: asthma, acute bronchitis, COPD, bronchiolitis
- Adverse Effects: HA, dizziness, dry mouth, insomnia, cough
- Contraindications/Warnings: Paradoxical bronchospasms, deterioration of asthma, CV effects, immediate HS rxns
Terbutaline
- SABA
- The only beta2 R agonist that is SubQ –> provides immediate axn w/ sustained delivery
- Contains sulfa and should not be used in pts w/ sulfa allergies
- Indications: Prophylactic trx of bronchospasm assoc w/ asthma, bronchitis, & emphysema in pts 12+
- Cautions: Not for tocolysis
- Adverse Effects: HA, nausea, tachycardia, palpitations
Meteproterenol
Indications: bronchial asthma, reversible bronchospasm which may occur in assoc w/ COPD & bronchitis
Caution: can produce a significant CV effect in some pts, can produce paradoxical bronchospasm
Pirbuterol
- Indications: Used in prevention & reversal of bronchospasms in pts 12+ w/ reversible bronchospasm including asthma. May be w/ or w/o concurrent theophylene/corticosteroid use.
- Caution: Can produce severe CV effects in some pts, as measured by pulse rate, BP, and/or sx. This allows for adequate monitoring.
Levalbuterol
- SABA
- Indications: Trx or prevention of bronchospasm in pts 4+ with reversible obstructive dz
- Warnings: Paradoxical bronchospasms
Fomoterol
- LABA
- Indications: trx of asthma in pts 5+ as an add-on to a long-term asthma control med, such as a corticosteroid. Maintenance trx in bronchoconstriction in pts w/ COPD.
- Warnings: Do NOT use without use of long-term asthma control med, such as inhaled corticosteroid. LABA’s have risk for increasing asthma related deaths and asthma-related hospital hospitalizations.
Salmeterol
- LABA
- Trx of asthma in pts 4+
- Prevention of exercise-induced bronchospasms (EIB) in pts 4+
- Maintenance trx of bronchospasms assoc w/ COPD
Indacaterol/Vilanterol
- LABA
- Trx breathing problems caused by COPD, including chronic bronchitis and emphysema
Olodaterol
- LABA
- Used as long-term, once daily maintenance bronchodilator trx of airflow obstruction in pts w/ COPD, chronic bronchitis, & emphysema
Suggested combination inhalers
- ICS + LABA
- Fluticasone + Salmeterol
- Mometasone + Formoterol
- Budesonide + Formoterol
What to prescribe for mild intermittent asthma/breathing issues?
Short-acting beta2-agonist
What to prescribe for mild persistent asthma/breathing issues?
SAB2-agonist & low dose of ICS
What to prescribe for moderate persistent asthma/breathing issues?
SAB2-agonist, low dose ICS, & LABA
What to prescribe for severe persistent asthma/breathing issues?
SAB2-agonist, high dose ICS, & LABA
What to prescribe for very severe persistent asthma/breathing issues?
SAB2-agonist, high dose ICS, LABA, & OCS
