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Bronchodilators
Lifestyle considerations with bronchodilatorsPatients or caregivers of patients using bronchodilators need to know how to monitor and measure responses to these medications. The correct use and maintenance of devices such as nebulizers, peak flow meters and inhalers are very important. Teenagers sometimes perceive a stigma associated with inhaler therapy because it can make them feel different, not well or not part of the group. Parents may wish to point out that many asthmatic athletes use bronchodilators and such people are proof that it is still possible to participate and excel in physical activities. People any age taking bronchodilators are encouraged to discuss their concerns and activity levels with their physicians. Some adolescents may deny having asthma or other breathing disorders that require bronchodilators and discontinue taking their medications. Caregivers need to be aware of this issue and monitor medication use until the adolescent is ready to manage his or her own care. Because bronchodilators are basically rescue medications, users need to have their medications with them at all times. Pregnancy use issues with bronchodilatorsCertain bronchodilators are used to treat asthma in pregnant women, including albuterol, bitolterol, formoterol, metaproterenol and salmeterol. Although there have been no studies on birth defects in humans, and no reported cases definitively linking birth defects to bronchodilators, some animal studies involving bronchodilators report birth defects when given in doses many times higher than human doses. Pregnant women who were given epinephrine under the skin have had more birth defects than expected in some studies, although the severity of the mother’s asthma may have contributed to this result. The medicines fenoterol, isoproterenol, pirbuterol, procaterol and terbutaline have not been shown to cause birth defects in animal studies. Women taking bronchodilators who are pregnant or wish to become pregnant are encouraged to discuss potential benefits and risks with their physician. It is not known at this time whether bronchodilators pass into the breast milk. Although most medicines pass into breast milk in small amounts, many of them are considered safe for nursing infants. Mothers who use bronchodilators and who wish to breast–feed are encouraged to discuss this with their physician. Child use issues with bronchodilatorsGenerally, bronchodilators are used on an as–needed basis when there is difficulty breathing or a child is having trouble with coughing or wheezing. If a child wheezes or coughs only after exercising, he or she may have exercise-induced asthma. Studies performed to date have not demonstrated specific problems that would limit the usefulness of bronchodilators in children. However, isoetharine is not recommended for their use. Bronchodilators routinely prescribed for children include: albuterol, bitolterol, levalbuterol, proventil, pirbuterol, terbutaline, levalbuterol. Elderly use issues with bronchodilatorsThe medicine salmeterol has been tested in a limited number of patients 65 years of age or older and has not been shown to cause different side effects or problems in older people than it does in younger adults. The medicines albuterol, bitolterol, epinephrine, fenoterol, isoetharine, isoproterenol, metaproterenol, pirbuterol, procaterol, and terbutaline have not been studied specifically in older adults. It is not known whether or not they work exactly the same way as they do in younger adults or if they cause different side effects among the older adult population.
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