Bronchodilators For Wheezing

Overview

Wheezing is a symptom of asthma and some other respiratory disease conditions. The wheezing sound is usually produced due to the narrowing of the air passage called bronchi which connects your windpipe to your lungs. 

The narrowing of the bronchi is usually treated with bronchodilators which help to relax the bronchi muscles and help you breathe without difficulty and without producing the wheezing sound. There are different types of bronchodilators.

In this article, we’ll briefly look into the causes and triggers of wheezing and also discuss bronchodilators, their types, how they work, and their side effects.

Understanding wheezing

A wheeze is a high-pitched whistling sound produced either while breathing in or breathing out due to the narrowing of any part¹ of your throat due to an allergic reaction that causes an inflammatory response, a respiratory infection, or a physical obstruction by a tumour or an object.

This narrowing causes an increased airway resistance i.e. It becomes difficult for air to go in and out of your bronchi. Some causes and triggers of wheezing include;

• Allergic reactions
• Respiratory infections
• Chronic Obstructive Pulmonary Disease (COPD)
• Asthma

Bronchodilators

Bronchodilators are medications that help to open up the airway. They relax the bronchi muscles thereby reversing the narrowing of the airway. Bronchodilators usually come in short or long-acting forms and have 3 classes.

Short-acting bronchodilators

Short-acting bronchodilators are also called fast-acting bronchodilators because they provide quick and rescue relief. It takes about 15 to 20 minutes and its effect can last up to 6 hours. They are used for treating the symptoms of the disease condition i.e. they are only used for symptomatic² treatment of sudden narrowing of airways, they do not affect the underlying respiratory condition.

Long-acting bronchodilators

Long-acting bronchodilators do not give immediate relief of the symptoms. They are usually taken to provide a long-term effect to prevent and control the narrowing of your airway. It takes several hours after its administration before you start experiencing its effects.

3 Classes of Bronchodilators

• Beta-2 agonist
• Anticholinergic
• Xanthine derivative

Beta-2 agonist

Beta-2 agonist or beta-2 adrenergic agonist is a group of bronchodilators that acts on the smooth muscles in your airway thereby causing them to become more relaxed and open making it easier for you to breathe. We have 2 types of beta-2 agonist, which are;

• Short-acting beta-2 agonist (SABA): This type of beta-2 agonist³ is used to provide quick relief to sudden respiratory symptoms. It works rapidly and its effects can last between 4-6 hours. Examples include; 
• Albuterol which is found in ProAir RespiClick, Proventil HFA, and, Accuneb.
• Levalbuterol (Xopenex HFA)
• Pirbuterol (Maxair)
• Metaproterenol
• Long-acting beta-2 agonist (LABA): LABA provides a more lasting effect but does not have a rapid onset of action. It takes a few hours before its effect can be seen and can last up to 12 hours. They are usually prescribed in combination with other types of inhalers.
  Examples include:
• Serevent (salmeterol)
• Foradil (formoterol)
• Striverdi (olodaterol)

Anticholinergic

This also helps to dilate the airway and relieve shortness of breath. Anticholinergics⁴ are effective in the management of asthma and COPD. It also has short-acting and long-acting variants.

• Short-acting anticholinergic: just as it has been explained above about short-acting bronchodilators, this also works in a similar way. An example of short-acting anticholinergic is ipratropium.
• Long-acting anticholinergic: examples of long-acting anticholinergic include, glycopyrronium, aclidinium, and umeclidinium (aclidinium and umeclidinium are both used in the treatment of COPD).

Xanthine derivative

This group of drugs⁵ also helps to dilate the airway and promote normal breathing by relaxing the bronchial smooth muscles. They also provide a long-term effect. It is usually prepared in severe cases of asthma. Examples are theophylline, pentoxifylline, and caffeine.

These bronchodilators cause your airway to open up by causing the smooth muscles in the airways to relax and therefore improve airflow. The choice of drug to be prescribed depends on the specific respiratory condition, the severity of symptoms, and each patient's unique needs. It is that for the full treatment of respiratory disorders like COPD and asthma, bronchodilators are frequently used in conjunction with other drugs, like inhaled corticosteroids.

Bronchodilators are available in different forms and be administered either orally or by inhalation and sometimes intravenously in cases where an individual is experiencing severe symptoms.

Potential side effects and precautions

Common side effects of bronchodilators include;

Beta-2 agonists and Xanthine Derivatives 

• Trembling
• Nervousness
• Muscle cramps
• Anxiety 
• dizziness
• Headaches
• Sudden palpitations.

Anticholinergic 

• Dry mouth
• Urine retention
• Increased heart rate
• Constipation 
• Stomach upset

Precautions

There are certain safety measures that patients and medical professionals need to be aware of when using or administering bronchodilators to guarantee optimal patient care. The kind of bronchodilator and the patient's general health may determine different precautions to be taken. These safety measures include:

Individual Sensitivity and Allergic reactions: Responses to bronchodilators vary from patient to patient. Some individuals may be more sensitive or allergic to the medications and may experience side effects even at lower doses. one has to be certain that the individual is not allergic to the medication before administering it. 

Drug Interactions: Bronchodilators may interact with other medications, including beta-blockers that are used for treating hypertension and certain antiarrhythmic drugs, and as such must be used cautiously while taking these medications. Healthcare providers must be aware of the patient's complete medication history to avoid potential adverse interactions.

Pregnancy and Breastfeeding: Pregnant or breastfeeding women should seek and follow the advice of their healthcare providers before using bronchodilators. While many bronchodilators are considered relatively safe, individual cases may vary, and professional guidance is important.

Diabetes: Patients with diabetes should use beta-2 agonists cautiously, as these medications can increase blood glucose levels. Regular monitoring of blood sugar may be necessary.

Adherence to Prescription: Patients need to follow the recommended dosage and frequency. The abuse or overuse of bronchodilators can result in tolerance, reduced efficacy, and a higher chance of adverse effects.

Regular Follow-up: To monitor how well the individual responds to treatment, treat any new concerns, and make necessary medication adjustments, subsequent visits with healthcare professionals are crucial.

Summary

In conclusion, bronchodilators play a vital role in managing wheezing associated with respiratory conditions like asthma and COPD. Understanding the various types of bronchodilators, their mechanisms of action, and appropriate usage is essential. 

However, individual health and allergy history need to be considered before administering bronchodilators. Regular monitoring, adherence to prescribed dosages, and close communication between healthcare providers and patients are important for optimising the benefits of bronchodilator therapy while reducing potential risks. Overall, a well-informed and individualized approach is key to achieving successful outcomes in the management of wheezing.