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Asthma Management: Quick-Relief Medications

The medications used for quick relief of bronchoconstriction and immediate reversal of airflow obstruction include short-acting beta2-agonists, anticholinergic agents, and systemic corticosteroids. TABLE 2 itemizes the advantages and disadvantages of the quick-relief medications that are used for the treatment of asthma symptoms. Short-acting beta2-agonists typically take effect within 5 to 15 minutes, causing a relaxation in airway smooth muscles and an improvement in airflow.Anticholinergic agents can provide additional relief of bronchoconstriction when used with beta2-agonists in severe exacerbations. These agents help reduce acute symptoms such as chest tightness, cough, and wheezing. Systemic corticosteroids take more than four hours to produce an effect. Nevertheless, in moderate to severe exacerbations these agents are useful in preventing progression and aiding resolution of airflow obstruction, as well as in decreasing relapse rate.

Asthma_Management_Quick-Relief_Medications

Table 2. Quick-Relief Medications
1. Short-Acting Inhaled Beta2-Agonists
Albuterol
Pirbuterol
Isoetharine
Levalbuterol (nebulized only)
Metaproterenol
Mechanism
Bronchodilator
Pros
Induce smooth muscle relaxation, which antagonizes bronchoconstriction
Provide quick relief of acute symptoms
Can be used prophylactically for exercise-induced bronchospasm
Cons
Tachycardia
Tremor
Possible headache
Possible hypokalemia, hyperglycemia
 
2. Anticholinergic Agents
Ipratropium bromide
Mechanism
Bronchodilator
Pros
Relieve acute bronchoconstriction that is cholinergically mediated
May reduce mucus gland secretion
Provide additive benefit to inhaled beta2-agonists in severe exacerbations
Alternative for patients who cannot tolerate inhaled beta2-agonists
Cons
Less potent bronchodilator
Use with caution in patients with narrow-angle glaucoma, prostatic hypertrophy, or bladder neck obstruction
 
3. Systemic Corticosteroids
Hydrocortisone
Methylprednisolone
Prednisolone
Prednisone
Mechanism
Anti-inflammatory
Pros
Prevent progression of exacerbation and reduce inflammation
Used for moderate-to-severe exacerbations
Cons (short-term use)
Fluid retention
Potential glucose intolerance, hypokalemia, gastric irritation

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