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 exercise capacity (ACSM 2013)
- 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.