Bronchodialators

Mechanism of Action

  • Inhibit bronchial smooth muscle constriction in patients with asthma or COPD.

Treatment

  • Asthma
  • Chronic Obstructive Pulmonary Disease (COPD)
  • Emphysema
  • Severe allergic reactions (anaphylaxis)
    • Epinephrine injection only

Types Bronchodilators

  • β2-adrenergic agonist
  • Xanthine Derivatives
  • Anticholinergic

Mechanism of Action

  • Inhibit bronchial smooth muscle constriction in patients with asthma or COPD.
  • Some bronchodilators also help to clear mucus and reduce inflammation in the lungs

Effect on Exercise and Rest

  • Resting Heart Rate
    • No effect on heart rate (ACSM 2013)
    • Varies depending on class of bronchodilotor (Gladson 2011)
  • Blood Pressure
    • No effect on blood pressure (ACSM 2013)
    • Varies depending on class of bronchodilotor (Gladson 2011)
  • Exercise capacit
    • No effect on exercise capacity (ACSM 2013)
      • Limited by bronchospasm
    • Varies depending on class of bronchodilotor (Gladson 2011)
  • No effect on ECG (ACSM 2013)
  • Decrease in Dyspnea (Gladson 2011)
  • Increase in exercising partial pressure of oxygen (EpaO) (Gladson 2011)

Sympathomimetics (β-Mimetics)

Mechanism of Action

  • Inhibit bronchial smooth muscle constriction in patients with asthma or COPD
  • Inhibits inflammatory cells in the airway from releasing inflammatory mediators and cytokines

Names

  • Short-acting β2 agonists
    • Albuterol or Salbutamol (ProAir, Proventil, ProAir RespiClick, and Ventolin)
    • Bitolterol (Tornalate)
    • Epinephrine injection (Adrenaclick, Adrenalin, EpiPen, Twinject Auto-Injector)
    • Fenoterol (Berotec)
    • Isoprenaline or Isoproterenol (Isuprel)
    • Levosalbutamol or Levalbuterol (Xopenex)
    • Orciprenaline or Metaproterenol (Alupent)
    • Pirbuterol (Maxair)
    • Procaterol (Meptin, Onsukil, Masacin, Procad)
    • Ritodrine (Yutopar)
    • Terbutaline (Bricanyl)
  • Long-acting β2 agonists
    • Arformoterol (Brovana)
    • Bambuterol (Bambec)
    • Clenbuterol (Dilaterol, Spiropent)
    • Formoterol (Foradil, Oxis, Perforomist)
    • Salmeterol (Serevent)
  • Ultra-long-acting β2 agonists
    • Abediterol
    • Carmoterol
    • Indacaterol (Arcapta Neohaler, Onbrez Breezhaler)
    • Olodaterol (Striverdi Respimat)
    • Vilanterol
      • with Umeclidinium bromide (Anoro Ellipta)
      • with Fluticasone furoate (Breo Ellipta, Relvar Ellipta)

Effect on Exercise and Rest

  • Increased resting heart rate (Gladson 2011)
  • Increased blood pressure (Gladson 2011)
  • Exercise Capacity (Gladson 2011)
    • Short-acting increase exercise capacity
    • Longer-acting may decrease exercise capacity
  • Decreased resting partial pressure of oxygen (RpaO) (Gladson 2011)
  • Increased exercising partial pressure of oxygen (EpaO) (Gladson 2011)

Xanthine Derivatives

Mechanism of Action

  • Nonselective phosphodisterase enzyme inhibitor
  • Dilates bronchi by blocking the action of phosphodiesterase (PDE) enzymes

Names

  • Theophylline (Theo 24, Elixophyllin, Uniphyl, Theolair, Slo-Bid)
  • Aminophylline (Aminophylline, Euphyllin, Phyllocontin, Somophyllin, Truphylline, Minomal)
  • Dyphyline (Dilor, Lufyllin)

Effect on Exercise and Rest

  • Increased resting heart rate (Gladson 2011)
  • Increase or decrease in blood pressure (Gladson 2011)
  • No change in exercise capacity (Gladson 2011)
  • Increased exercising partial pressure of oxygen (EpaO) (Gladson 2011)

Anticholinergics

Mechanism of Action

  • Blocks the effect of acetylcholine on airways and nasal passages, causing the muscles to relax and airways to dilate

Names

  • Ipratropium (Atrovent)
  • Tiotropium (Spiriva Respimat)
  • Aclidinium (Tudorza Pressair)
  • Umeclidinium (Incruse Ellipta)
  • Glycopyrrolate (Seebri Neohaler)

Effect on Exercise and Rest

  • Decrease resting heart rate (Gladson 2011)
  • No change in blood pressure (Gladson 2011)
  • Increase in exercise capacity (short-acting) (Gladson 2011)
  • No change in resting partial pressure of oxygen (RpaO) (Gladson 2011)
  • Increased exercising partial pressure of oxygen (EpaO) (Gladson 2011)

Other Effects

  • Decreased exacerbations (Gladson 2011)
  • Increased quality-of-life measures (Gladson 2011)
  • Very low levels of adverse effects (Gladson 2011)

Bronchodilators for Exercise

  • Effects of bronchodilators on exercise capacity in patients with COPD (Gladson 2011)
    • Anticholinergics have the most significant effect on exercise capacity with high dose therapies generally resulting in greater effects
    • Short-acting β2 sympathominetrics also have significant positive effects on exercise capacity
    • Longer-acting β2 sympathominetrics do not produce significant effects
    • Methylxanthines have negative effects on exercise capacity
    • An addition of a second bronchiodilator has no advantage in improving exercise capacity
    • Most bronchioddilators can reduce dyspnea, even in the absence of exercise capacity improvements
  • Effects of bronchodilators on quality-of-life measures in patients with COPD (Gladson 2011)
    • Anticholinergics appear to improve quality-of-life measures more than long-acting bronchodilators
  • Anticholinergics (compared to other classes of bronchodilators) in patients with COPD (Gladson 2011)
    • More effective in decreasing dyspnea
    • Have fewer central effects at rest
    • Better attenuate right heart afterloads during exercise
    • Have fewer adverse effects

Recommendations

  • Exercise at the same time each day so drug plasma levels are consistent (Gladson 2011)
  • Carry a rescue inhaler during exercise if it has been prescribed (Gladson 2011)
  • Monitor for signs of right ventricular failure (Gladson 2011)

References

American College of Sports Medicine (2013). Guidelines for Exercise Testing and Prescription, William & Wilkins, 9, 401.

Gladson B (2011). Pharmacology for Rehabilitation Professionals, Elsevier Saunders (2) 490-492.

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