While short acting bronchodilators (SABAs) like Albuterol are the primary rescue medications used for the relief of acute chest tightness, coughing, shortness of breath, and wheezing associated with asthma, your physician may prescribe other medications to use as part of your asthma care plan or in the office or emergency department.
We will discuss:
- SABAs (e.g. Albuterol)
- Anticholinergics (e.g. Atrovent)
- Steroids (e.g. Prednisone)
SABAs
SABAs provide relief of bronchoconstriction, or the tightening of muscles in the lung, by relaxing smooth muscles. Within minutes the smooth muscles relax, bronchoconstriction decreases, airflow obstruction decreases, and breathing becomes easier.
Frequent use of SABAs over a short time period is an effective way to relieve asthma symptoms, but while providing relief, frequent SABA use is a sign of poor asthma control. If you need to use a SABA more than twice per week or go through a single SABA inhaler in less than a month, your asthma is under poor control.
SABAs are most effective when inhaled through a metered dose inhaler or delivered through a nebulizer so that the medication can act directly in the lung. In very young children, some healthcare providers still use oral SABAs, but side effects are more common. In general inhaled SABAs are preferred because symptoms improve faster and side effects are less common.
SABA side effects include:
- rapid heart rates
- restlessness
- headache
- ruscle tremors
- low potassium
- sleep disorders
Anticholinergics
Anticholinergic drugs provide smooth muscle relaxation and relief of obstruction by acting on different receptors in the lung. Because anticholinergic drugs act on different cell receptors than the bronchodilators, many physicians will combine the use of anticholinergics with bronchodilators for the acute relief of airway obstruction in an asthma attack.
While beta-agonists act in minutes and last only minutes, anticholinergics take longer to produce an effect and last longer. It may take up to 30 minutes for 80% of the bronchodilatory effect to be produced and the effects may last up to 6 hours. As such, anticholinergics are not appropriate for the acute treatment of asthma symptoms alone. Inhaled anticholinergics are generally well tolerated with few systemic side effects compared to beta-agonists.
Steroids
After an hour of treatment, the rate of improvement in airflow obstruction significantly decreases. Taking systemic steroids either by mouth or through an intravenous (iv) line can significantly speed up improvement by decreasing inflammation in the lung. Current guidelines recommend steroids for any patient with a PEFR of less than 70% of predicted.
Symptom improvement after steroid administration generally takes at least 6 hours.
Side effects associated with short-term use include:
- increased appetite
- indigestion
- nervousness or restlessness
- dizziness or lightheadedness
- flushing of face or cheeks
- hiccups
- increased sweating
Your health care provider has a number of different quick relief medications to help treat your asthma. You likely will use a SABA as part of your asthma care plan, but overuse is a sign of poor control. Your health care provider may also use steroids and anticholinergics in specific situations if your asthma has worsened. Understanding the role of each of these medications and their potential side effects will help you gain better control of your asthma.
Sources:
Conditions A-Z FamilyDoctor.org. Accessed December 30 2008. Asthma: Controller and Quick-Relief Medicine
National Heart, Lung, and Blood Institute. Accessed: January 1, 2009. Expert Panel Report 3 (EPR3): Guidelines for the Diagnosis and Management of Asthma
Asthma. In Chest Medicine: Essentials Of Pulmonary And Critical Care Medicine. Editors: Ronald B. George, Richard W. Light, Richard A. Matthay, Michael A. Matthay. May 2005, 5th edition.
