Pharmacology of the Airways

Abstract

Short-acting beta-2 adrenergic agonists are administered for the acute relief of bronchospasm, wheezing, and airflow obstruction. Long-acting beta-2 adrenergic agonists are for long-term control of symptoms. Inhaled anticholinergics are first-line therapy in COPD. They are useful for both maintenance therapy and in acute exacerbations. Inhaled corticosteroids are used to control inflammation in asthma and COPD. In asthma, they can be used as monotherapy. In COPD, they are used in conjunction with long-acting beta-adrenergic agonists and long-acting antimuscarinic antagonists. Systemic corticosteroids are used for the reduction of inflammation in asthma and COPD exacerbations and are not typically prescribed as maintenance therapy. Phosphodiesterase 4 inhibitors can be used in patients with severe COPD who have a history of bronchitis and exacerbations. Leukotriene modifiers, mast cell stabilizers, and methylxanthines are alternative therapies used in asthma when symptoms are not well-controlled on first-line therapy. Volatile and intravenous anesthetics provide a degree of bronchodilation that may be useful in treating intraoperative bronchoconstriction. Helium/oxygen mixtures, antihistamines, and magnesium sulfate are alternative therapies used when bronchospasm does not respond to conventional therapies.