Reliever medicines should be used for symptom relief as a rescue medicine for the relief of breathlessness. They are called short-acting (because they work quickly) bronchodilators.
They work by relaxing the muscles around the breathing tubes or airways. This helps to open up the breathing tubes or airways which reduces the obstruction and allows air to flow out of and into the lungs when you breathe – easing your feelings of breathlessness and increasing your ability to exercise.
Relievers often work within minutes of inhalation and their effects last for several hours.
There are two types of reliever or bronchodilator medications – short acting beta2-agonists (SABA) and short acting muscarinic antagonists (SAMA). Short-acting muscarinic antagonists are also known as short acting anticholinergic agents.
Terbutaline (Bricanyl®) given by a Turbuhaler and sometimes by a nebuliser.
Salbutamol (Asmol®, Airomir®, Ventolin®): given by a spacer and puffer and sometimes a nebuliser.
Use
Always carry a short-acting reliever with you for acute situations or when doing exercise such as attending a pulmonary rehabilitation program or Lungs in Action class.- If you are using more than you usually do, your condition may be getting worse or you might have an infection. You should see your GP as you may require a longer lasting inhaler or other medicine.
Effects
- Lasts for up to four hours.
- Works within minutes to relieve symptoms.
- Can be taken prior to exercise if needed.
Side effects
- Headaches, anxiety or nervousness.
- Nausea.
- Muscle tremors.
- Increased or irregular heartbeats.
Ipratropium bromide (Atrovent®)
Use
- Has a slower onset than short-acting beta2-agonists, but it lasts longer.
Effects
- Relaxes smooth muscles in your lungs and opens up breathing tubes or airways in a different way compared with beta2-agonists.
- It helps improve quality of life and breathlessness.
- Lasts for up to six hours.
Side effects
- Minor adverse effects such as dry mouth, urinary retention and blurred vision are common.
- Has been shown to increase risk of adverse cardiovascular events.
- Should NOT be used in conjunction with any muscarinic antagonists, i.e. any medicines with a LAMA.
Maintenance medicines will help to reduce your COPD symptoms in the long term and can help to prevent flare ups. There are two types of maintenance medications – Long Acting Muscarinic Antagonists (LAMA) and Long Acting Beta2-Agonists (LABA). Long acting muscarinic antagonists are also known as long acting anticholinergic agents.
All maintenance inhalers work in one of two different ways to relax the muscles around the breathing tubes or airways. You can be prescribed one type alone, or may receive a combination of both types.
Tiotropium (Spiriva® HandiHaler® & Spriva® Respimat®)
Glycopyrronium bromide (Seebri® Breezehaler®)
Aclidinium bromide (Bretaris® Genuair®)
Umeclidinium (Incruse Ellipta®)
Use
- Do not use to treat an acute situation (use a short-acting reliever instead)
- Inhale once daily only. (Bretaris®, twice daily).
- Spiriva® and Seebri® capsules are not to be swallowed
- Should not be used in conjunction with Atrovent®
Effects
- Relaxes smooth muscles in your lungs and opens the breathing tubes or airways.
- Lasts for 12 to 24 hours depending on the medicine.
- Improves your lung function which can improve your quality of life.
- Helps to prevent flare ups.
Side effects
- Dry mouth, urinary retention and blurred vision.
- Use with caution if you have a prostate problem.
- Narrow angle glaucoma.
Eformoterol (Oxis® Turbuhaler®, Foradile® Aerolizer®)
Salmeterol (Serevent® Accuhaler®)
Indacaterol (Onbrez® Breezhaler®)
Use
- Do not use to treat an acute situation (use a short-acting beta2-agonist instead).
- Should be taken twice a day (morning and night) except for Onbrez® which is taken once a day.
Effects
- Relaxes smooth muscles in your lungs.
- Improves your lung function which can improve your quality of life.
- Lasts for up to 12 or 24 hours, depending on the inhaler.
Side effects
- Tremor, headache and a rapid heartbeat.
Indacaterol / glycopyrronium (Ultibro® Breezhaler®)
Umeclidinium / vilanterol (Anoro® Ellipta®)
Aclidinium / Formoterol (eformoterol) (Brimica® Genuair®
Tiotropium / olodaterol (Spiolto® Respimat®)
Use
- Should not be used with other medicines containing a LABA and/or LAMA.
- Ultibro® – Inhale once a day.
- Spiolto® – Inhale once a day.
- Anoro® – Inhale once a day.
- Brimica® – Inhale twice a day.
Effects
- Works by relaxing the muscles around the airways in the lungs so they open up to make breathing easier.
- Must be used regularly to be effective. It does not work immediately and should not be used to relieve sudden shortness of breath. If sudden breathing problems occur, use your quick-relief inhaler as prescribed.
Side Effects
- Headaches, anxiety or nervousness.
- Nausea
- Muscle tremors.
- Increased or irregular heartbeats.
(Nuelin®, Theo-Dur®)
Use
- Use twice (daily).
- For use in severe COPD with frequent flare ups.
- Is less often used because of the potential for more significant side effects.
- Regular blood tests are required.
- Take with food.
- Available in controlled release tablet and syrup.
Effects
- Theophylline relaxes the bronchial smooth muscle and reduces inflammation in the breathing tubes or airways.
- There are both short-acting (works for 6 hours) and long-acting (works for 12-24 hours) forms of theophylline.
Side effects
- Theophylline is associated with more frequent side effects and therefore is used less often than other bronchodilators. If you have been prescribed theophylline, your doctor may wish to monitor you more closely.
- Tremor, nervousness, light-headedness, nausea and vomiting.
