BRONCHODILATOR

Dr. M. Yulis Hamidy,

M.Kes., M.Pd.Ked

INTRODUCTION
A bronchodilator is a substance
that dilates the bronchi and
bronchioles, increasing airflow
Bronchodilators may be
endogenous (originating naturally
within the body), or they may be
medications administered for the
treatment of breathing difficulties

HISTORY
The history of bronchodilators goes back 4000
years to a Chinese doctor named Ma Huang,
who devised a bronchodilator using Ephedra
The first modern-day bronchodilators,
developed about 70 years ago, included
ephedrine and adrenaline
Prior to that, whisky, caffeine, tobacco, and
chloroform were used to treat paroxysms of the
bronchial tubes.

INDICATION
Bronchial asthma is the most
common application of these drugs
They are also intended to help
improve the breathing capacity of
patients with COPD (Chronic
Obstructive Pulmonary Diseases),
eg: emphysema, pneumonia and
bronchitis

ACTION
Act on 2 receptors in bronchial smooth muscle
and bronchial mucous membranes
Bronchodilators are either short-acting or longacting.
Short-acting medications provide quick or "rescue"
relief from acute bronchoconstriction
Long-acting bronchodilators help to control and
prevent symptoms

PRECAUTION
Overactive thyroid, heart disease,
high blood pressure, epilepsy, diabetes, any
drug allergies
This medication should be used only when
clearly needed during pregnancy
This drug may be excreted into breast milk
Anticholinergics are not recommended for
people with glaucoma or urinary disorders

TYPE
1 Short-acting 2-agonists
2 Long-acting 2-agonists
3 Anticholinergics
4 Theophylline
5 Corticosteroids

Short-acting 2-agonists

These are quick-relief or "rescue" medications that

provide fast, temporary relief from asthma symptoms or
flare-ups
Take effect within 20 minutes or less, and can last from
four to six hours
These inhaled medications are best for treating sudden
and severe or new asthma symptoms
Taken 15 to 20 minutes ahead of time, these medications
can also prevent asthma symptoms triggered by exercise
or exposure to cold air

Long-acting 2-agonists

These are long-term medications taken routinely in order to control and

prevent bronchoconstriction
They are not intended for fast relief
Take longer to begin working, but relieve airway constriction for up to 12
hours
Inhaled - Commonly taken twice a day with an anti-inflammatory
medication, they maintain open airways and prevent asthma symptoms,
particularly at night.
Oral - Long-acting albuterol is available in pill or syrup form.
Effective for 12 hours, albuterol is particularly helpful for nighttime
asthma symptoms. Because this medication requires high dosing, there
tend to be increased side-effects
Side-effects include increased heart rate; hyperactivity; feeling nervous,
shaky, or over-excited; and, very rarely, upset stomach or difficulty
sleeping

Anticholinergics

Relax the muscles and reduce muscle contractions

(spasms), by interfering with nerve signals to muscles
Only available as an inhalant, ipratropium bromide
relieves acute or new asthma symptoms
It is most often paired with a short-acting 2-agonist
While it is considered a relief or rescue medication, it can
take a full hour to begin working. For this reason, it plays
a minor role in asthma treatment
Dry throat is the most common side-effect. If the
medication gets in contact with the eyes, it may cause
blurred vision for a brief time

Theophylline

Thought to relax muscles by directly affecting the muscle

fibres
Available in oral and injectable form
A long-acting bronchodilator that prevents asthma
episodes
It belongs to the chemical class methyl xanthines (along
with caffeine)
Prescribed in severe cases of asthma or those that are
difficult to control
It must be taken 1-4 times daily, and doses cannot be
missed

Theophylline
Side-effects can include nausea, vomiting,
diarrhea, stomach or headache, rapid or
irregular heart beat, muscle cramps, nervous or
jittery feelings, and hyperactivity. It may
promote acid reflux, by relaxing the lower
esophageal sphincter muscle
Interaction: erythromycin, can interfere with the
way theopylline works. Coffee, tea, colas,
cigarette-smoking, and viral illnesses can all
affect the action of theophylline and change its
effectiveness

Corticosteroids
Relax muscles and reduce
inflammation
Usually effective in a few days and
often reduce frequency of attacks
Next on steroids.