Quick-relief medications

Bronchodilators work primarily by relaxing airway muscles, allowing airways to open up and making breathing easier.

Inhaled, short-acting beta-agonists are the most commonly prescribed family of bronchodilators because they work rapidly, are convenient to use, have few side effects and can be targeted directly to the lungs. Beta-agonists are used to provide quick relief from symptoms during an asthma episode. These drugs come in various forms, including tablets, syrups, metered-dose inhalers (MDIs) and nebulized solutions.

When used with a metered-dose inhaler, the beta-agonist goes directly into the airways to ease the bronchospasm. Relief from asthma symptoms begins within five minutes to 15 minutes and lasts for about four hours to six hours. Longer-lasting beta-agonists, such as salmeterol and formoterol fumarate, are not “rescue” inhalers and should not be used in place of faster-acting beta-agonists when immediate relief from an asthma episode is needed.

Beta-agonists in syrup, tablet and nebulizer forms can be used with young children and others who have difficulty using an inhaler. The syrup and tablet forms, however, work more slowly than the inhaled forms (MDI and nebulizer) and can have more side effects.

Like any medication, beta-agonists may have side effects. If these medications are taken in an inhaled form, proper inhalation technique also is very important to ensure that the medication reaches the lungs. In most cases, inhalers should not be used more than two puffs every four hours to six hours. If you need relief more frequently than this, talk with your doctor. You may need a different medication. Overuse of beta-agonists is a common sign of uncontrolled asthma. It also increases the chance for possible side effects, including rapid heartbeat, nervousness or headache.

Anticholinergics are another class of quick-relief medication sometimes used in treating asthma. The inhaled medication ipratropium bromide (Atrovent®) offers additional, fast-acting relief from acute episodes. They are most often used along with a beta-agonist to help relieve coughing during an episode or provide additional bronchodilation; they begin working 30 minutes after they’re taken. Anticholinergics work by blocking signals in the nervous system that tell the body to cough and by relaxing the smooth airway muscles. Combivent® (inhaler) and DuoNeb® (nebulizing solution) are combined beta-agonist and anticholinergic products.

Oral corticosteroids, the strongest asthma medications, are used primarily for those with severe asthma. They also are used to provide relief from severe asthma episodes. These medications begin to work within eight hours to 12 hours of the first dose. Available in tablet and liquid forms, oral corticosteroids manage asthma very effectively for short periods of time, when other medications are ineffective.

Long-term use of oral corticosteroids is avoided whenever possible because of potential side effects. People who have severe asthma that cannot be controlled adequately with other medications, however, may need to take oral corticosteroids for longer periods. This should be done only with your doctor’s supervision. If needed, your health care provider can recommend a dosing schedule that minimizes the risk of more serious side effects.

Oral corticosteroids used for asthma control are not the same as anabolic steroids used by weight lifters and other athletes to build muscle mass. Oral corticosteroid medications are synthetic replicas of steroids produced in the body.

Because inflammation and mucus in the upper airways, such as the sinuses, nasal passages and the throat, also can affect the lungs’ small airways, medications to relieve these symptoms also can help your asthma.