Quick-Relief Medications Used to Treat Asthma

Quick-relief medications give fast relief for tight, narrowed airways and the symptoms of coughing, wheezing, and chest tightness that happen with asthma.

Examples of quick-relief medications: Proventil HFA, ProAir HFA, Ventolin HFA, albuterol, Maxair, and Xopenex.
View a complete listing of asthma medications.

Quick-relief medications (listed in alphabetical order) (EPR-3, p. 214):

• Anticholinergics: Inhibit muscarinic cholinergic receptors and reduce intrinsic vagal tone of the airway. Ipratropium bromide provides additive benefit to short-acting beta-agonist (SABA) in moderate-to-severe asthma exacerbations. May be used as an alternative bronchodilator for patients who do not tolerate SABA.
• Short-acting beta₂-agonists (SABAs): Albuterol, levalbuterol, and pirbuterol are bronchodilators that relax smooth muscle. Therapy of choice for relief of acute symptoms and prevention of EIB.
• Systemic corticosteroids: Although not short acting, oral systemic corticosteroids are used for moderate and severe exacerbations as adjunct to SABAs to speed recovery and prevent recurrence of exacerbations.

Short-acting beta₂-agonists

Inhaled short-acting beta₂-agonists are the drug of choice for treating acute asthma symptoms and attacks, or flare-ups.

When is it used?

• For relief of acute symptoms and prevent exercise-induced bronchospasm.

How does it work?

• Bronchodilation: relax bronchial smooth muscle following adenylate cyclase activation and increase in cyclic AMP producting functional antagonism of bronchocontriction., usually within 5 to 10 minutes of administration (opens up the airways by working on a cellular level).

Possible side effects:

• Increased heart rate, shakiness, hypokalemia, increased lactic acid, headache, high blood sugar. Inhaled route, in general, causes few side effects.
• Patients who already have heart disease, especially the elderly, may have harmful cardiovascular reactions with inhaled therapy.

Other information about using this type of medication:

• Inhaled route starts working faster, has fewer side effects, and works better than oral medication. The less beta₂-selective agents (isoproterenol, metaproterenol, isoetharine, and epinephrine) are not recommended due to their potential for excessive cardiac stimulation, especially in high doses. Albuterol liquid is not recommended.
• For patients with intermittent asthma, regularly scheduled daily use neither harms nor benefits asthma control. Regularly scheduled daily use is not generally recommended.
• If the medication does not seem to be working, or if it needs to be used too often (more than 1 canister/month) means that the asthma is not under control, and a doctor needs to evaluate and possibly increase (or start) long-term control therapy. Use of greater than 2 canisters/month poses additional adverse risks.

Oral (systemic) corticosteroids

Used for moderate-to-severe exacerbations to speed recovery and prevent recurrence of exacerbations.

When is it used?

• Usually requires short-term (3-10 days) "burst", broad anti-inflammatory effects.
• Broad anti-inflammatory effects- to stop an asthma flare-up, reverse inflammation, speed recovery and reduce rate of relapse.

How does it work?

• Anti-inflammatory. Blocks late reaction to allergen and reduce airway sensitivity. Inhibit cytokine production, adhesion protein activation, and inflammatory cell migration and activation at the cellular level.
• Reverse beta₂-receptor down-regulation. Inhibit microvascular leakage.

Possible side effects:

• Short-term use: reversible changes in sugar metabolism, increased appetite, fluid retention, weight gain, mood alteration, hypertension, peptic ulcer, and rarely aseptic necrosis of femur.
• Consideration should be given to coexisting conditions that could be worsened by systemic corticosteroids, such as herpes virus infections, varicella, tuberculosis, hypertension, peptic ulcer, and Strongyloides.

Other information about using this type of medication:

• Short-term therapy should continue until patient achieves 80% Peak Expiratory Flow personal best or symptoms resolve. This usually requires 3 to 10 days, but may require longer.
• There is no evidence that tapering the dose following improvement prevents relapse.

Anticholinergics (ipratropium bromide)

May provide some additive benefit to inhaled beta₂-agonists in severe asthma attacks. May be an alternative bronchodilator for patients who do not tolerate inhaled beta₂-agonists.

When is it used?

• For relief of acute bronchospasm.

How does it work?

• Bronchodilation. Competitive inhibition of muscarinic cholinergic receptors (opens the airways by working at the cellular level).
• Reduces intrinsic vagal tone to the airways. May block reflex bronchoconstriction secondary to irritants or to reflux esophagitis.
• May decrease mucus gland secretion (so body makes less mucus).

Possible side effects:

• Drying of mouth and respiratory secretions, increased wheezing in some people, blurred vision if sprayed in eyes.

Other information about using this type of medication:

• Reverses only cholinergically mediated bronchospasm; does not modify reaction to antigen. Does not block exercise-induced bronchospasm.
• May provide additive effects to beta₂-agonist but has slower onset of action.
• Is an alternative for patients with intolerance to beta₂-agonists.
• Treatment of choice for bronchospasm due to beta-blocker medication.

Adapted from the Guidelines for the Diagnosis and Management of Asthma, National Asthma Education and Prevention Program of the National Heart, Lung and Blood Institute, Expert Panel Report 3, 2007.