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Research ArticleSymposium Papers

Inhaled Beta Agonists

Timothy B Op't Holt
Respiratory Care July 2007, 52 (7) 820-832;
Timothy B Op't Holt
Department of Cardiorespiratory Care, University of South Alabama, Mobile, Alabama
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Abstract

The β2 adrenoreceptor is a large molecule of some 413 amino acids. The duration of stimulation of this receptor depends on where and for how long a β2 adrenergic drug attaches itself to the β2 adrenoreceptor. β2 adrenergic drugs have been used for over 5,000 years, but only recently have we had the advantage of adrenergic drugs specific to the β2 adrenoreceptor. The short-acting β2 adrenergic drugs most frequently used include albuterol, pirbuterol, and levalbuterol. Levalbuterol, the R enantiomer of albuterol, has been described by some as a more effective bronchodilator than racemic albuterol, because it contains none of the S enantiomer. Some contend that the S isomer has pro-inflammatory properties. The 2 long-acting β2 adrenergic drugs are salmeterol and formoterol. These drugs have a duration of 12 h and reportedly improve forced expiratory volume in the first second, quality of life, and symptoms. Some recent reports indicate that these drugs are associated with higher mortality, but several authors have registered the opinion that it is not the bronchodilator that should be questioned, but instead that the fault lies in the patient recruitment in those studies. Regardless, if these long-acting drugs are effective for a given patient, it would seem inadvisable to withdraw them, given the current state of evidence. Arformoterol tartrate, the R enantiomer of formoterol, was approved by the U.S. Food and Drug Administration in October 2006; it is available as a nebulizer solution, to be administered every 12 h. Several other long-acting R isomers and RR isomers are in the approval pipeline.

  • inhaled agonist
  • adrenoreceptor
  • albuterol
  • pirbuterol
  • levalbuterol
  • bronchodilator
  • salmeterol
  • formoterol

Footnotes

  • Correspondence: Timothy B Op't Holt EdD RRT AE-C FAARC, Department of Cardiorespiratory Care, University of South Alabama, 1504 Springhill Avenue, Mobile AL 36604–3273. E-mail: toptholt{at}jaguar1.usouthal.edu.
  • The author presented a version of this paper at the 22nd Annual New Horizons Symposium at the 52nd International Respiratory Congress of the American Association for Respiratory Care, held December 11–14, 2006, in Las Vegas, Nevada.

  • The author reports no conflicts of interest related to the content of this paper.

  • Copyright © 2007 by Daedalus Enterprises Inc.
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Respiratory Care: 52 (7)
Respiratory Care
Vol. 52, Issue 7
1 Jul 2007
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Inhaled Beta Agonists
Timothy B Op't Holt
Respiratory Care Jul 2007, 52 (7) 820-832;

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Timothy B Op't Holt
Respiratory Care Jul 2007, 52 (7) 820-832;
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Keywords

  • inhaled agonist
  • adrenoreceptor
  • albuterol
  • pirbuterol
  • levalbuterol
  • bronchodilator
  • salmeterol
  • formoterol

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