Bronchodilators – Tests & treatments

Bronchodilators are a type of medication that make breathing easier. They do this by relaxing the muscles in the lungs and widening the airways (bronchi).

They’re often used to treat long-term conditions where the airways may become narrow and inflamed. This includes:

• asthma – a common lung condition caused by inflammation of the airways
• chronic obstructive pulmonary disease (COPD) – a lung disease that blocks the airways

Bronchodilators may be either:

• short-acting – used as short-term relief from sudden, unexpected attacks of breathlessness
• long-acting – used regularly to help control breathlessness in asthma and COPD

Bronchodilators and corticosteroids

Inhaled corticosteroids are the main treatment for asthma. They reduce inflammation and prevent flare-ups.

However, some people may also benefit from taking bronchodilators. These help to keep the airways open and enhance the effects of corticosteroids.

In people with asthma, long-acting bronchodilators should never be taken without corticosteroids.

In COPD, treatment is given with short or long-acting bronchodilators first. Corticosteroids are then added in some severe cases.

Treatment with corticosteroids and bronchodilators may require the use of separate inhalers. However, increasingly these medications are provided together in a single inhaler.

Types of bronchodilator

The 3 most widely used bronchodilators are:

• beta-2 agonists – like salbutamol, salmeterol, formoterol and vilanterol
• anticholinergics – like ipratropium, tiotropium, aclidinium and glycopyrronium
• theophylline

Beta-2 agonists and anticholinergics are available in both short-acting and long-acting forms. Theophylline is only available as an oral tablet in a long-acting form.

Beta-2 agonists

Beta-2 agonists are used for both asthma and COPD, although some types are only available for COPD. They’re usually inhaled using a small, hand-held inhaler. They may also be available as tablets or syrup.

For sudden, severe symptoms they can also be injected or nebulised. A nebuliser is a compressor used to turn liquid medication into a fine mist. This allows a large dose of the medicine to be inhaled through a mouthpiece or face mask.

Beta-2 agonists stimulate receptors called beta-2 receptors in the muscles that line the airways. This causes them to relax and allows the airways to dilate (widen).

They should be used with caution in people with:

• an overactive thyroid (hyperthyroidism) – a condition that occurs when there’s too much thyroid hormone in the body
• cardiovascular disease – any disease of the heart or blood vessels
• an irregular heartbeat (arrhythmia)
• high blood pressure (hypertension)
• diabetes – a lifelong condition that causes a person’s blood sugar level to become too high

In rare cases, beta-2 agonists can make some of the symptoms and possible complications of these conditions worse.

Anticholinergics

Anticholinergics (also known as antimuscarinics) are mainly used for COPD. A few are also licensed for asthma.

They’re usually taken using an inhaler. However, some may be nebulised to treat sudden and severe symptoms.

Anticholinergics cause the airways to dilate by blocking the cholinergic nerves. These nerves release chemicals that can cause the muscles lining the airways to tighten.

They should be used with caution in people with:

• benign prostatic hyperplasia – a non-cancerous swelling of the prostate
• a bladder outflow obstruction – any condition that affects the flow of urine out of the bladder, like bladder stones or prostate cancer
• glaucoma – a build-up of pressure in the eye

In people with benign prostatic hyperplasia or a bladder outflow obstruction, anticholinergics can cause problems urinating.

Glaucoma can get worse if anticholinergic medication unintentionally gets into the eyes.

Theophylline

Theophylline is taken in tablet form.

It’s unclear exactly how theophylline works. However, it seems to reduce any inflammation (swelling) in the airways and relaxes the muscles lining them.

The effect of theophylline is weaker than other bronchodilators and corticosteroids. It’s also more likely to cause side effects, so is often only used alongside these medicines if they’re not effective enough.

Theophylline should be used with caution in people with:

• an overactive thyroid
• cardiovascular disease
• liver problems – like liver disease
• high blood pressure
• stomach ulcers – open sores that develop on the stomach lining
• epilepsy – a condition that affects the brain and causes repeated seizures (fits)

Theophylline may cause these conditions to get worse. In people with liver problems, it can sometimes lead to a dangerous build-up of medication in the body.

Other medicines can also cause abnormal build-up of theophylline in the body. This should always be checked by your doctor.

Elderly people may also need extra monitoring while taking theophylline.

Side effects of bronchodilators

Bronchodilators can sometimes cause side effects, although these are usually mild or short-lived.

The side effects of bronchodilators can vary depending on the specific medication you’re taking. Make sure you read the leaflet that comes with your medication to see what the specific side effects are.

Pregnancy and breastfeeding

In most cases, bronchodilators should be taken as normal while pregnant or breastfeeding.

However, speak to your GP if you regularly use bronchodilators and are considering having a baby or think you might be pregnant.

Pregnancy may affect your asthma. This means it’s important to continue taking your medication and have it monitored regularly. This will ensure that the condition is controlled.

Interactions with other medicines

Bronchodilators may interact with other medicines. This could affect the way they work or increase your risk of side effects.

Some of the medicines that can interact with bronchodilators (particularly theophylline) include:

• some diuretics – a type of medication that helps remove fluid from the body
• some antidepressants – including monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants (TCAs)
• digoxin – a medication used to treat arrhythmias
• benzodiazepines – a type of sedative that may be used as a short-term treatment for anxiety or sleeping problems (insomnia)
• lithium – a medication used to treat severe depression and bipolar disorder
• quinolones – a type of antibiotic medication

This isn’t a complete list of all the medications that can interact with bronchodilators. Also, not all of these interactions apply to each type of bronchodilator.

You should always read the patient information leaflet (PIL) that comes with your medication. You may be able to find a specific PIL in the MHRA database on GOV. UK.

If in doubt, speak to your pharmacist or GP.

Bronchitis (for Parents) – Nemours KidsHealth

What Is Bronchitis?

Bronchitis is when the lining of the large breathing tubes gets inflamed (swollen and red). These airways, called the bronchial tubes, connect the windpipe to the lungs. Their delicate lining makes mucus, and covers and protects the organs and tissues involved in breathing.

Bronchitis (brong-KYE-tis) can:

• Make it hard for air to pass in and out of the lungs.
• Irritate the tissues of the bronchial tube lining. Then, it causes them to make too much mucus.

The most common symptom of bronchitis is a lasting cough.

What Are the Types of Bronchitis?

Bronchitis can be acute or chronic:

Acute bronchitis comes on quickly and can cause severe symptoms. But it lasts no more than a few weeks. Viruses cause most cases of bronchitis. Many different viruses can infect the respiratory tract and attack the bronchial tubes. Infection by some bacteria can also cause acute bronchitis. Most people have acute bronchitis at some point in their lives.

Chronic bronchitis is rare in children. It can be mild to severe and lasts longer (from several months to years). The most common cause of chronic bronchitis is smoking. The bronchial tubes stay inflamed and irritated, and make lots of mucus over time. People who have chronic bronchitis have a higher risk of bacterial infections of the airway and lungs, like pneumonia.

What Are the Signs & Symptoms of Bronchitis?

Acute bronchitis often starts with a dry, annoying cough triggered by the inflammation of the lining of the bronchial tubes.

Other symptoms may include:

• coughing that brings up thick white, yellow, or greenish mucus
• feeling short of breath
• soreness or a feeling of tightness in the chest
• wheezing (a whistling or hissing sound with breathing)
• headache
• generally feeling ill
• fever
• chills

For people with chronic bronchitis:

• It can take longer than usual to recover from colds and other common respiratory illnesses.
• Wheezing, feeling short of breath, and coughing can happen every day.
• Breathing can get harder and harder.

What Causes Bronchitis?

Acute bronchitis is usually caused by a virus. It may happen along with or after a cold or other respiratory infection. Viruses can spread:

• when someone with bronchitis coughs and sends infected droplets into the air
• when someone touches their mouth, eyes, or nose after contact with respiratory fluids from an infected person

Things that put people at risk for chronic bronchitis include:

• smoking, even for a short time
• being around tobacco smoke
• exposure to chemical fumes and other air pollutants for long periods

How Is Bronchitis Diagnosed?

When doctors suspect bronchitis, they will do an exam and listen to a child’s chest with a stethoscope to check for wheezing and congestion.

No tests are needed to diagnose bronchitis. But the doctor may order a chest X-ray to rule out a condition like pneumonia. Sometimes doctors do a breathing test (called spirometry) to check for asthma. Some kids who seem to get bronchitis a lot — with coughing, wheezing, and shortness of breath — may have asthma instead.

How Is Bronchitis Treated?

Doctors won’t prescribe an antibiotic for bronchitis caused by a virus. Antibiotics work only against bacteria, not viruses.

Home care helps most kids with bronchitis feel better. The doctor will recommend that kids and teens:

• drink lots of liquids
• get plenty of rest

For some older kids or teens, doctors might say it’s OK to give an over-the-counter or prescription cough medicine to ease coughing. They also sometimes prescribe a bronchodilator (brong-ko-DY-lay-ter) or other medicines that treat asthma. These help relax and open the bronchial tubes and clear mucus so it’s easier to breathe. Kids usually get these medicines through inhalers or nebulizer machines.

A child or teen with chronic bronchitis should avoid being near whatever irritates their bronchial tubes. For people who smoke, that means quitting. Tobacco smoke causes more than 80% of all cases of chronic bronchitis. Smokers also take longer to recover from acute bronchitis and other respiratory infections.

Can Bronchitis Be Prevented?

Washing hands well and often can help prevent the spread of many of the germs that cause bronchitis, especially during cold and flu season.

Encourage anyone in your family who smokes to quit. Protect kids — with or without bronchitis — from secondhand smoke. It can put them at risk for viral infections and increased congestion in their airways.

Reviewed by: Yamini Durani, MD

Date reviewed: April 2023

CHRONIC BRONCHITIS AND COPD – gb2mgn74.ru

Why the technical benefits of civilization do not allow timely detection of COPD? Who is at higher risk of getting sick? What can’t X-ray show? Can I get hooked on an inhaler? And why does Crimea need to be taken in the right doses? In an interview with a pulmonologist at the City Hospital No. 2, Margarita Ruvimovna Lokotskova.

The entire respiratory system is divided into two parts: conductive and direct gas exchange. We are talking about the conduction system and a violation of its conductivity, that is, about bronchial diseases, which, the pulmonologist emphasizes, are much more common than diseases of the gas exchange system. As a rule, these are chronic bronchitis, COPD (chronic obstructive pulmonary disease) and bronchial asthma.

– Margarita Ruvimovna, what symptoms of bronchitis and COPD can a person notice on their own?

– In chronic bronchitis there is inflammation: a cough that lasts for 3 months for at least 2 years, a lot of sputum, often purulent. With exacerbations of bronchitis, sometimes there is an obstructive syndrome. The main symptom of COPD is shortness of breath. Unfortunately, modern man determines its presence late due to the use of the technical benefits of civilization: cars, elevators. Therefore, the patient comes to the doctor already with severe shortness of breath, when you have to use inhalers.

– What is obstruction?

– Obstruction is a compression of the bronchus, which can occur due to various reasons: infectious or non-infectious inflammation.

– How can you tell if you are short of breath?

– Focus on yourself. Those loads that previously did not cause shortness of breath, but now pass with it, are a symptom.

– Who is at higher risk of getting sick?

– A number of professions can lead to illness. For example, the risk group for COPD includes miners, cooks who have been working for more than ten years, workers in a metallurgical plant, and people who work with fur. This also includes production factors, dust, smoking, frequent exacerbation of chronic bronchitis. This leads to compression of the bronchus, and it is difficult for air to pass through such a bronchus. As a rule, this is accompanied by mucosal edema. When this happens over time, we talk about chronic obstructive pulmonary disease.

– What about the environment as a risk factor?

– This also needs to be taken into account. We live in a dusty city, with industrial and automotive emissions that we breathe. When dust enters the lungs, it enters into a chemical interaction with the bronchial mucosa. This is how microrubs are formed. They also give bronchial sclerosis. The bronchi become less mobile, active, and then obstruction may also occur.

– We all live in the same city, but not everyone gets COPD. Why?

– Because some of us are predisposed to lung disease, some are not. You can work in production all your life and have no problems with your lungs, and someone will have changes in 10 years.

– What diagnostic methods do you use?

– Spirography helps to determine how advanced the changes are. It measures the function of external respiration. Changes can also be detected on x-ray of the lungs. For a pulmonologist, this is sacred. We see tuberculosis, tumor, pneumonia, but not all physiological changes. Let’s say the patient complains that he is suffocating, but we will not see asthma attacks in the pictures. For a pulmonologist, sputum analysis is very informative, it is done by our laboratory. The analysis shows whether this is a bacterial or allergic manifestation. Sputum culture – which antibiotics are better to prescribe.

– What is better in treatment: tablets or inhalers?

– Asthma and COPD do not come first with pills. There is not a single pill that does not affect other organs. But inhalers only work on the lungs. Surprisingly, patients are often afraid to “get hooked” on the inhaler. It is not true. People eat bread every day, drink water, but this does not mean that they are “hooked” on them. These things are the needs of the body. And it is the same with inhalers: there is a need – people use it, there is no need – they do not use it, it is impossible to “get hooked” on them. Inhalers are divided into those that stop an attack, help breathe, help a person not suffocate. And those that treat, but do not stop attacks. Moreover, a course is needed, because the inflammation will not go away in one breath. Finally, there are 2 in 1 inhalers that both stop and treat.

– What should be considered when using cough suppressants?

– These drugs must be taken correctly. This means understanding the principle of their action. Expectorants are taken only in the presence of sputum. If you start taking a thinning drug against the background of a dry cough, you will only increase the cough, but will not help yourself, because there is nothing to dilute. If the cough is dry, it is better to take drugs that suppress the cough, but they should not be taken if there is phlegm. In the absence of allergies, herbs help well – for example, breast fees, licorice root, hyssop. They won’t dilute the excess, they won’t intensify the cough.

– Tell us about affordable and effective prevention.

– Now there are all kinds of vaccines with different numbers of strains. Some of them can be placed once in a lifetime, others – once every 5 years. Then you need to try to avoid hypothermia, less likely to meet with substances that provoke attacks of suffocation. For example, perfume, tobacco smoke. Pay attention to general strengthening treatment. Remember Chekhov, Voloshin, Green. Many Russian writers with lung and bronchial diseases lived in the Crimea and felt well. I have a favorite phrase – to the Crimea for a month. The keyword is monthly. Because many with weak immunity left for a week, returned and got sick. Or they fell ill there, returned sick. It is necessary to endure the aggravation there, go into remission and leave healthy.

Dear visitors of the site, you can make an appointment with the pulmonologist of the City Hospital No. 2 Margarita Ruvimovna Lokotskova under the MHI policy or under the contract of paid (paid) medical services by phone – 22-37-35.

Who needs inhalation and when?

11/25/2021
Abramov Oleg Sergeevich

Text not provided in full. You can read the entire article on FORM – SBER EAPTEKI’s blog. We tell you which cough nebulizer to choose, and how to do inhalation correctly.

Previously, people breathed steam from potatoes. We have already written about the uselessness of this and many other folk methods. Therefore, we will talk about correct, hardware inhalation, using a nebulizer. It can help relieve acute coughing, reduce discomfort, and improve quality of life. We tell you which nebulizer to choose for cough treatment, and how to do inhalation correctly.

How are nebulizers different?

There are several types of nebulizers:

• Compressors
• Ultrasonic
• Diaphragm

Each has its pros and cons. An important task of a nebulizer is to deliver a medicinal substance to the site of inflammation in the upper and lower respiratory tract. Ultrasound can destroy medicinal active substances, while the effectiveness of treatment is reduced. For home use, it is better to choose compressor or membrane. The first ones are more expensive and weigh more, but they do not need additional parts and are easy to wash. The second ones are convenient to take on a trip, they are silent, but you need to buy consumables for them.

For children under 5 years of age, inhalations are carried out while sitting using a special mask, which should fit snugly to the nose and mouth. Starting from the age of 5, children as well as adults breathe through the mouthpiece that comes with the mask. Inhale air through the mouth through the mouthpiece, exhale through the nose. After inhalation, rinse the mask, mouthpiece, and tubes with running water and soap, and dry thoroughly.

Indications and contraindications

Usually inhalations are prescribed for obstructive bronchitis, bronchial asthma, chronic obstructive pulmonary disease, croup syndrome.

“The nebulizer is used only to deliver a medicinal substance to the respiratory mucosa,” says Anastasia Shledovitz, a pediatrician at the Fantasy Children’s Clinic, “therefore, there are not so many main indications for its use: bronchodilators for bronchial obstruction, inhaled hormones for croup syndrome, and combined drugs for bronchial asthma. Self-prescribing these drugs can be harmful, especially for young children.”

In the presence of a runny nose, sinusitis, sore throat, adenoids, with redness of the throat, inhalation is not recommended.

“Often in children during the adenoid period, cough and runny nose can drag on and go beyond the normal course of SARS, that is, last more than 10 days,” says Oleg Abramov, otorhinolaryngologist, head of the GMS Hospital Operative Surgery Center. – Such a cough should be treated with proper drug therapy aimed at reducing snot. Inhalations with saline or hormonal agents will not have any effect in terms of cough relief.

Inhalations are most often prescribed for a sharp cough. The course of treatment is usually from 1 to several days. With a “residual cough” after ARVI that occurs after sleep and when leaving a warm room for a cold one and vice versa, treatment is usually not required.

“If a child or an adult coughs for more than three weeks due to mucus dripping down the back of the throat,” Oleg Abramov adds, “this requires an ENT doctor’s consultation to conduct an endoscopic examination and identify the cause that may lead to this.”

In the absence of pathology of the nasopharynx, but a prolonged cough persists, it is necessary to visit a gastroenterologist, pediatrician or therapist, in some cases, an infectious disease specialist.

What solutions can be added to the nebulizer?

Only those that are indicated in the instructions for the use of the drug: budesonide, impratropium bromide, ventolin, fluimucil – an antibiotic.