Rescue Medications & How They Work

Quick Relief Medications ForThe Improvement Of Acute Asthma Symptoms

Woman using rescue inhaler
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While short-acting bronchodilators (SABAs) like Albuterol are the primary rescue medications used for the relief of acute chest tightness, coughing, shortness of breath, and wheezing associated with asthma, your physician may prescribe other medications to use as part of your asthma care plan or in the office or emergency department.

We will discuss:

  • SABAs (e.g. Albuterol)
  • Anticholinergics (e.g. Atrovent)
  • Steroids (e.g. Prednisone)

SABAs

SABAs provide relief of bronchoconstriction, or the tightening of muscles in the lung, by relaxing smooth muscles. Within minutes of using the smooth muscles relax, the constricted muscles in the airways release, airflow obstruction decreases, and breathing becomes easier as more air moves through your respiratory tract.

Frequent use of SABAs over a short time period is an effective way to relieve asthma symptoms and improve breathing, but while providing relief, frequent SABA use is a sign of poor asthma control. If you need to use a SABA more than twice per week or go through a single SABA inhaler in less than a month, your asthma is under poor control. You need to see your doctor and discuss actions such as beginning or increasing the dose of an inhaled steroid.

SABAs are most effective when inhaled through a metered dose inhaler using a spacer or delivered through a nebulizer so that the medication can act directly in the lung.

In very young children, some healthcare providers still use oral SABAs, but side effects are more common and the oral forms of the medication are not as effective as an inhaler with a spacer. In general, inhaled SABAs are preferred because symptoms improve faster and side effects are less common.

SABA side effects include:

  • rapid heart rates
  • restlessness
  • headache
  • muscle tremors
  • low potassium
  • sleep disorders

Anticholinergics

Anticholinergic drugs provide smooth muscle relaxation and relief of obstruction by acting on different receptors in the lung. Because anticholinergic drugs act on different cell receptors than the bronchodilators, many physicians will combine the use of anticholinergics with bronchodilators for the acute relief of airway obstruction in an asthma attack. Anticholinergics can be combined together with bronchodilators in a nebulizer or delivered as separate inhalers with a spacer. There are also several inhalers that combine anticholinergics and bronchodilators that can be used in adults.

While beta-agonists act in minutes and have an effective therapeutic duration of only minutes, anticholinergics take longer to produce an effect and the effect lasts longer. It may take up to 30 minutes for 80% of the bronchodilatory effect to be produced on inhalation and the effects may last up to 6 hours. As such, anticholinergics are not appropriate for the acute treatment of asthma symptoms alone.

Inhaled anticholinergics are generally well tolerated with few systemic side effects compared to beta-agonists. Some of the reported side effects include:

  • headache
  • dry mouth
  • hoarseness
  • cough
  • stuffy nose and sinus pain
  • nausea and upset stomach
  • flu-like symptoms
  • blurred vision
  • dizziness

Steroids

After an hour of treatment, the rate of improvement in airflow obstruction significantly decreases. Taking systemic steroids either by mouth or through an intravenous (iv) line can significantly speed up improvement by decreasing inflammation in the lung. Current guidelines recommend steroids for any patient with a PEFR of less than 70% of predicted.

Symptom improvement after steroid administration generally takes at least 6 hours. Generally, your doctor will ask you if you have needed steroids previously or if you appear ill enough on presentation they will err on the side of giving steroids. Your doctor will also ask a bunch of questions and perform tests to make sure you do not have an active bacterial infection. The result of giving systemic steroids to someone with an active bacterial infection is similar to what happens when you pour fire starter on an active fire and can lead to you significantly worsening.

Side effects associated with short-term steroid use include:

  • increased appetite
  • indigestion
  • nervousness or restlessness
  • dizziness or lightheadedness
  • flushing of face or cheeks
  • hiccups
  • increased sweating
  • Elevated glucose levels

Over time if you require many doses of steroids you are increased the risk for high blood pressure, cataracts in the eyes, poor blood sugar control, and bone problems such as osteoporosis.

Your health care provider has a number of different quick relief medications to help treat your asthma. You likely will use a SABA as part of your asthma care plan, but overuse is a sign of poor control. Your health care provider may also use steroids and anticholinergics in specific situations if your asthma has worsened. Understanding the role of each of these medications and their potential side effects will help you gain better control of your asthma.

Sources:

FamilyDoctor.org. Asthma Treatment. Accessed February 28, 2016.

National Heart, Lung, and Blood Institute. Accessed: February 28, 2016. Expert Panel Report 3 (EPR3): Guidelines for the Diagnosis and Management of Asthma

Asthma. In Chest Medicine: Essentials Of Pulmonary And Critical Care Medicine. Editors: Ronald B. George, Richard W. Light, Richard A. Matthay, Michael A. Matthay. May 2005, 5th edition.

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