Bronchodilators

Precautions :

Bronchodilators come with patient instructions that must be carefully read before using the medicine. If there is any confusion about how to use the medicine, patients should check with the physician or pharmacist. These medicines must be used exactly as directed. Taking larger than recommended doses or using the medicine too often can lead to serious side effects and even death.

If symptoms do not improve or if they get worse after using a bronchodilator, the patient should call a physician right away.

Although some bronchodilators are available without a physician's prescription, these medicines should not be used unless a physician has diagnosed the patient's condition as asthma.

Research shows that frequent bronchodilator use over time can tighten airway muscles in some people. Some physicians advise patients to consider controlling asthma with anti-inflammatory drugs including inhaled steroids such as beclomethasone dipropionate (Beclovent, Vanceril), flunisolide (AeroBid) or triamcinolone acetonide (Azmacort). A 2004 Canadian study has questioned a standard practice of increasing steroids after asthma attacks or worsened symptoms. Also, research in 2004 showed that people with asthma who worked closely with their physicians to self-manage their asthma had fewer attacks, which reduces the need for bronchodilators. Carefully managing asthma also reduces visits to the emergency department and hospitalizations.

Persons with diabetes should be aware that the bronchodilator epinephrine may raise their blood sugar levels.

Patients who are using an aerosol bronchodilator and an aerosol form of either ipratropium or a corticosteroid such as beclomethasone dipropionate (Beclovent, Vanceril) should use the bronchodilator first, then wait 5 minutes before using the other medicine. A physician should be consulted before using any other inhaled medications or other asthma medicines. The physician must determine the proper amount of time between doses.

Some bronchodilator products contain sulfites that trigger an allergic reaction in certain people. Anyone who has a sulfite allergy should read the label carefully or check with a physician or pharmacist before using a bronchodilator. Call a physician immediately if any of these signs of an allergic reaction to sulfite occur:

• bluish coloration of the skin
• flushed or red face or skin
• faintness
• severe dizziness
• increased wheezing or other breathing problems
• skin rash, hives, or itching
• swelling of the face, lips, or eyelids

Special conditions

People with certain medical conditions or who are taking certain other medicines can have problems if they use bronchodilators. Before using these drugs, a physician should be made aware of any of these conditions:

ALLERGIES. Anyone who has had unusual reactions to any bronchodilator or an inhaled form of any other drug in the past should let his or her physician know before taking the drugs again. The physician should also be told about any allergies to foods, dyes, preservatives, or other substances.

Patients who are allergic to soybeans, soy lecithin, peanuts, or drugs based on atropine should not use the bronchodilator ipratropium (Atrovent).

PREGNANCY. In studies of laboratory animals, some bronchodilators cause birth defects or miscarriage when the animals are given doses many times the usual human dose. Whether these drugs cause such problems in humans in unknown. Any woman who is pregnant or plans to become pregnant should check with her physician before using a bronchodilator.

BREASTFEEDING. Some bronchodilators pass into breast milk. Breastfeeding mothers should check with their physicians before using bronchodilators.

OTHER MEDICAL CONDITIONS. Before using bronchodilators, people with any of these medical problems should make sure their physicians are aware of their conditions:

• glaucoma
• brain damage
• convulsions (seizures)—recently or anytime in the past
• mental illness
• parkinson's disease
• diabetes
• heart or blood vessel diseases
• rapid or irregular heartbeat
• high blood pressure
• overactive thyroid
• enlarged prostate
• obstruction of the neck of the bladder

USE OF CERTAIN MEDICINES. Using bronchodilators with certain other drugs may affect the way the drugs work or may increase the chance of side effects.

KEY TERMS

Anti-inflammatory—Medicine used to relieve swelling, pain, and other symptoms of inflammation.

Bronchitis—Inflammation of the air passages of the lungs.

Chronic—A word used to describe a long-lasting condition. Chronic conditions often develop gradually and involve slow changes.

Emphysema—A lung disease in which breathing becomes difficult.

Inflammation—Pain, redness, swelling, and heat that usually develop in response to injury or illness.

Nebulizer—A device that turns liquid forms of medicine into a fine spray that can be inhaled.

Sulfite—A type of preservative that causes allergic reactions in some people.