The Role of Beta 2 Agonists in Asthma

Beta 2 agonists are a type of bronchodilator used in the treatment of asthma. Beta 2 agonist medications stimulate beta cells, which relax the smooth muscles of your airways that tighten as part of the pathophysiology of asthma to cause symptoms such as:

  • Wheezing
  • Chest tightness
  • Shortness of breath
  • Chronic cough

Some beta 2 agonists are short-acting SABAs, while others are long-acting LABAs.

Pediatrician explaining inhaler to patient and mother
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How Do Beta Agonists Fit Into My Asthma Treatment

It is important to understand how different medications fit into your asthma action plan. With beta-agonists, the answer is it depends on the formulation. Some beta-agonists are long-acting and others are short-acting.

The short-acting beta-agonists are used for the acute, short-term relief of symptoms. In your asthma action plan, this will be referred to as your rescue inhaler. When your peak flow drops below a certain number or you develop wheezing or shortness of breath, your action plan will instruct you on how to use your rescue inhaler. In fact, one of the tenants of poor asthma control is needing to use a short-acting beta-agonist more than twice per week.

Long-acting beta-agonists or LABAs, on the other hand, are taken daily when part of your prevention strategy. However, LABAs are not usually used as a monotherapy in asthma. They are generally part of a combination of asthma products such as Advair or Symbicort. These drugs combine an inhaled steroid and a LABA into one inhaler. When used in a combination product, the LABA will generally be used daily.

There are some physicians who are beginning to look at whether or not one of these combination inhalers could be used as the only inhaler for your asthma. A systematic review compared a standard therapy (inhaled steroids plus separate rescue inhaler) with a single combination inhaler containing an inhaled steroid/LABA combination both twice daily as prevention and then as needed for worsening symptoms. The single inhaler treatment did not decrease asthma exacerbations requiring admission to the hospital, but there were fewer adult patients who had asthma exacerbations requiring oral corticosteroids like Prednisone. While not significant enough to change standard practice, the results are very interesting and there is further ongoing research.

What About Side Effects?

Side effects of the various beta 2 agonists are similar, and include:

  • Appetite changes
  • Dizziness
  • Headache
  • Hyperactivity
  • Nausea or feeling sick to your stomach
  • Nervousness
  • Shakiness
  • Sinus pain
  • Sore throat
  • Tremor
  • Trouble sleeping
  • Vomiting

More serious side effects of beta 2 agonists include:

  • Allergic reactions such as rash, hives, difficulty breathing, swelling of the mouth, face, lips, or tongue
  • Chest pain
  • Ear pain
  • Fast or irregular heartbeat
  • Hoarseness
  • Pounding in the chest
  • Red, swollen, blistered, or peeling skin
  • A severe headache or dizziness
  • Trouble breathing

Some of the Medications Your Doctor Might Prescribe

Examples of beta 2 agonists include:

  • Proventil HFA
  • Ventolin HFA
  • Proair HFA
  • Xopenex HFA
  • Alupent
  • Serevent (salmeterol)
  • Foradil (formoterol)
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Article Sources
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