Table of ContentsView AllTable of ContentsWhat They AreHow They WorkIndicationsPrecautions and ContraindicationsDosageSide EffectsWarnings and Interactions
Table of ContentsView All
View All
Table of Contents
What They Are
How They Work
Indications
Precautions and Contraindications
Dosage
Side Effects
Warnings and Interactions
Short-acting beta-agonists (SABAs) are a class of prescription drugs used to quickly relieve shortness of breath and wheezing in people withasthma.
IAN HOOTON/SPL / Getty Images
SABAs are considered the frontline defense for acuteasthma symptoms. They are most often inhaled via ametered-dose inhaler(using a pressurized canister) or as a dry powder that you simply breathe in, but are also available as tablets, syrups,nebulizedsolutions, injectable solutions, and even intravenous solutions.
SABAs are one of several classes of drugs known asbronchodilatorsbecause they dilate (open) the airways known as the bronchi and bronchioles.
When used as a rescue medication, a SABA can relievedyspnea(shortness of breath) and wheezing within minutes. After one or two puffs, the drug will remain active for around four to six hours and can be used from three to six times a day depending on the formulation.
The FDA has approved one medication that combines a SABA and an inhaled corticosteroid (ICS) for the treatment of acute asthma symptoms and prevention of future asthma attacks:
How Asthma Is Treated
How SABAs Work
SABAs, along with closely relatedlong-acting beta-agonists (LABAs), belong to a class of drugs known as beta2(β2)-adrenergic receptor agonists. By definition, agonists are drugs that bind to a cell receptor to trigger a specific reaction.
The receptor in this case is the beta2-adrenergic receptor, which relaxes smooth muscles. Smooth muscles are those in the walls of hollow organs that contract and relax involuntarily to, among other things, move food through the intestines, regulate blood pressure and circulation, or—as is relevant to asthma—open and close airways in the lungs.
The receptors are considered adrenergic because they respond to the hormone epinephrine (adrenaline) that helps regulate smooth muscle function. By mimicking epinephrine, beta-agonists can bind to adrenergic receptors and trigger a chain reaction in which calcium is quickly released from channels within smooth muscles, causing them to relax.
When applied to the lungs, this effect will cause the bronchi and bronchioles to quickly dilate, allowing more air to enter. It also alleviatesbronchospasmsthat cause chest tightness and coughing during an asthma attack.
Indications for Use
How SABAs are used to treat asthma depends on the frequency or severity of symptoms:
SABAs are also approved to treatchronic obstructive pulmonary disease (COPD)and otherobstructive lung disorders.
Differences Between Asthma and COPD
Off-Label Uses
SABAs are frequently used off-label to treat respiratory distress in people with severelower respiratory infections, although their usefulness in this respect is unproven.
There are few absolute contraindications to SABAs other than a known allergy to the drug or an inactive ingredient in the formulation. If you are allergic to albuterol, you should not use levalbuterol (or vice versa).
SABAs are known to affect pulse rate, blood pressure, blood sugar, and thyroid hormone production and, on rare occasions, induce seizures. While not contraindicated for use, SABAs should be used with caution in people who have:
Results from animal studies show that use of albuterol or levalbuterol in pregnancy has the potential to be harmful to developing fetuses, but no well-controlled trials in humans have been conducted.
However, uncontrolled asthma puts both a developing fetus and the pregnant person at risk. People with asthma should have access to asthma medications and learn from their healthcare providers when they should use them.
Based on the statistical risk, the drugs are unlikely to pose any harm. Even so, before taking them it is important to tell your healthcare provider if you are pregnant, planning to get pregnant, or breastfeeding, so that you can weigh the benefits and risks of use.
The recommended dosage of albuterol and levalbuterol varies according to the formulation as well as the age of the person who will be taking it. Among the approved formulations:
Tablets and syrups are prescribed used less often but may be appropriate for children and adults who can’t tolerate or properly use inhaled medications.
How to Take and Store
SABAs should never be used in excess of the recommended dose. Overuse can lead to premature drug tolerance and treatment failure.
Of the three inhaled formulations, MDIs need to be primed before use if not recently used. This involves shaking and spraying the inhaler away from your face to clear the aerosol valve. (DPIs and nebulizers can be used as needed.)
The various inhalers also need to be regularly cleaned to avoid clogging and insufficient dosing:
The medications can be safely stored at room temperature (ideally between 68 and 77 degrees F). Keep the drug in its original packaging away from direct sunlight and where children cannot see or reach it.
Do not use a SABA after its expiration date.
Inhaler vs. Nebulizer: Which is Better?
The side effects of the various SABA formulations are largely the same. However, because inhaled SABAs are delivered straight to the lungs and therefore do not affect other organs in the body, they tend to have milder and shorter-lasting side effects than oral or intravenous SABAs.
Inhaled or NebulizedTremors of the hands, arms, legs, or feetIrregular or rapid heartbeatsHeart palpitationsNervousnessDizziness or lightheadednessChest tightnessCough or sore throatRunny noseOral or IntravenousTremors of the hands, arms, legs, or feetIrregular heartbeatHeart palpitationsNervousnessDizziness or lightheadednessChest tightnessHeadacheNauseaDry mouthDiarrheaInsomniaFlushing or rednessSweatingPrickly or burning skin sensations
Inhaled or NebulizedTremors of the hands, arms, legs, or feetIrregular or rapid heartbeatsHeart palpitationsNervousnessDizziness or lightheadednessChest tightnessCough or sore throatRunny nose
Tremors of the hands, arms, legs, or feet
Irregular or rapid heartbeats
Heart palpitations
Nervousness
Dizziness or lightheadedness
Chest tightness
Cough or sore throat
Runny nose
Oral or IntravenousTremors of the hands, arms, legs, or feetIrregular heartbeatHeart palpitationsNervousnessDizziness or lightheadednessChest tightnessHeadacheNauseaDry mouthDiarrheaInsomniaFlushing or rednessSweatingPrickly or burning skin sensations
Irregular heartbeat
Headache
Nausea
Dry mouth
Diarrhea
Insomnia
Flushing or redness
Sweating
Prickly or burning skin sensations
When to Call 911
On rare occasions, SABAs can cause paradoxical bronchospasm—meaning breathing symptoms get worse rather than better. Why this happens is unclear, but it seems to occur most often in people withallergic asthmawho have severely inflamed airways.
SABA-induced paradoxical bronchospasm should always be considered a medical emergency.
Allergies to SABAs are rare but can occur. Call 911 or seek emergency care if you develop hives or rash, difficulty breathing, abnormal heartbeats, confusion, or the swelling of the face, throat, tongue, or throat. These are signs of a potentially life-threatening, whole-body allergy known asanaphylaxis.
Routine monitoring of heart function,blood glucose, orthyroid functionis recommended for anyone in an at-risk group who takes albuterol. The treatment may need to be stopped if symptoms worsen or diagnostic test results fall well outside of the acceptable range of values.
Because of their effect on heart rhythms, never use more of an SABA than prescribed. On rare occasions overuse of albuterol or levalbuterol has causedmyocardial infarction(heart attack) or stroke.
Beta2-agonists are known to interact with certain classes of drugs. In some cases, the interaction may increase the activity of a drug (raising the risk of side effects). In others, it may decrease the blood concentration of a drug (reducing its effectiveness).
Among the drugs that may interact with SABAs are:
To avoid interactions, let your healthcare provider know about any and all drugs you are taking, whether they are prescription, over-the-counter, herbal, or recreational.
A Word From Verywell
Though rescue inhalers like albuterol and levalbuterol are safe and effective for relieving acute asthma symptoms, it is important not to overuse them. Some people will do out so of panic if the drug is “not working fast enough,” while others will overuse SABAs to avoid having to take other longer-acting drugs. Both of these are signs that your condition is not being well controlled.
As a rule of thumb, if you need to use a rescue inhaler more than twice weekly, your asthma is being poorly controlled.By speaking with your healthcare provider and being honest about your inhaler use, you should be better able to find the right combination of drugs to control your asthma symptoms.
15 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.GlaxoSmithKline.Ventolin HFA (albuterol sulfate) inhalation aerosol.Sunovion Pharmaceuticals.Xopenex HFA (levalbuterol tartrate) inhalation aerosol, for oral inhalation use.Billington CK, Penn RB, Hall IP.β Agonists.Handb Exp Pharmacol. 2017;237:23-40. doi:10.1007/164_2016_64Almadhoun K, Sharma S.Bronchodilators. In: StatPearls.Jiang J, Li L, Yin H, et al.Single- and multiple-dose pharmacokinetics of inhaled indacaterol in healthy Chinese volunteers. Eur J Drug Metab Pharmacokinet.2015;40(2):203-8. doi:10.1007/s13318-014-0197-6MedlinePlus.Albuterol oral inhalation.Sellers WFS.Inhaled and intravenous treatment in acute severe and life-threatening asthma.Brit J Anaesth.2013;10(2):183-90. doi:10.1093/bja/aes444Kitaguchi Y, Fujimoto K, Komatsu Y, Hanaoka M, Honda T, Kubo K.Additive efficacy of short-acting bronchodilators on dynamic hyperinflation and exercise tolerance in stable COPD patients treated with long-acting bronchodilators.Respir Med. 2013;107(3):394-400. doi:10.1016/j.rmed.2012.11.013Rasmussen LK, Schuette J, Spaeder MC.Albuterol use in children hospitalized with human metapneumovirus respiratory infection.Int J Pediatr. 2016;2016:7021943. doi:10.1155/2016/7021943Teva Pharmaceutical.ProAir (albuterol sulfate) inhalation aerosol.Eltonsy S, Kettani FZ, Blais L.Beta2-agonists use during pregnancy and perinatal outcomes: a systematic review.Respir Med.2014;108(1):9-33. doi:10.1016/j.rmed.2013.07.009Da Silva D, Jacinto T.Inhaled β-agonists in asthma management: an evolving story.Breathe (Sheff). 2016;12(4):375-7. doi:10.1183/20734735.017116Magee JS, Pittman LM, Jette-Kelly LA.Paradoxical bronchoconstriction with short-acting beta agonist.Am J Case Rep. 2018;19:1204-7. doi:10.12659/AJCR.910888Aljaafareh A, Valle JR, Lin YL, Kuo YF, Sharma G.Risk of cardiovascular events after initiation of long-acting bronchodilators in patients with chronic obstructive lung disease: A population-based study.SAGE Open Med. 2016;4:2050312116671337. doi:10.1177/2050312116671337American Academy of Allergy, Asthma & Immunology.Inhaled asthma medications.
15 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.GlaxoSmithKline.Ventolin HFA (albuterol sulfate) inhalation aerosol.Sunovion Pharmaceuticals.Xopenex HFA (levalbuterol tartrate) inhalation aerosol, for oral inhalation use.Billington CK, Penn RB, Hall IP.β Agonists.Handb Exp Pharmacol. 2017;237:23-40. doi:10.1007/164_2016_64Almadhoun K, Sharma S.Bronchodilators. In: StatPearls.Jiang J, Li L, Yin H, et al.Single- and multiple-dose pharmacokinetics of inhaled indacaterol in healthy Chinese volunteers. Eur J Drug Metab Pharmacokinet.2015;40(2):203-8. doi:10.1007/s13318-014-0197-6MedlinePlus.Albuterol oral inhalation.Sellers WFS.Inhaled and intravenous treatment in acute severe and life-threatening asthma.Brit J Anaesth.2013;10(2):183-90. doi:10.1093/bja/aes444Kitaguchi Y, Fujimoto K, Komatsu Y, Hanaoka M, Honda T, Kubo K.Additive efficacy of short-acting bronchodilators on dynamic hyperinflation and exercise tolerance in stable COPD patients treated with long-acting bronchodilators.Respir Med. 2013;107(3):394-400. doi:10.1016/j.rmed.2012.11.013Rasmussen LK, Schuette J, Spaeder MC.Albuterol use in children hospitalized with human metapneumovirus respiratory infection.Int J Pediatr. 2016;2016:7021943. doi:10.1155/2016/7021943Teva Pharmaceutical.ProAir (albuterol sulfate) inhalation aerosol.Eltonsy S, Kettani FZ, Blais L.Beta2-agonists use during pregnancy and perinatal outcomes: a systematic review.Respir Med.2014;108(1):9-33. doi:10.1016/j.rmed.2013.07.009Da Silva D, Jacinto T.Inhaled β-agonists in asthma management: an evolving story.Breathe (Sheff). 2016;12(4):375-7. doi:10.1183/20734735.017116Magee JS, Pittman LM, Jette-Kelly LA.Paradoxical bronchoconstriction with short-acting beta agonist.Am J Case Rep. 2018;19:1204-7. doi:10.12659/AJCR.910888Aljaafareh A, Valle JR, Lin YL, Kuo YF, Sharma G.Risk of cardiovascular events after initiation of long-acting bronchodilators in patients with chronic obstructive lung disease: A population-based study.SAGE Open Med. 2016;4:2050312116671337. doi:10.1177/2050312116671337American Academy of Allergy, Asthma & Immunology.Inhaled asthma medications.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
GlaxoSmithKline.Ventolin HFA (albuterol sulfate) inhalation aerosol.Sunovion Pharmaceuticals.Xopenex HFA (levalbuterol tartrate) inhalation aerosol, for oral inhalation use.Billington CK, Penn RB, Hall IP.β Agonists.Handb Exp Pharmacol. 2017;237:23-40. doi:10.1007/164_2016_64Almadhoun K, Sharma S.Bronchodilators. In: StatPearls.Jiang J, Li L, Yin H, et al.Single- and multiple-dose pharmacokinetics of inhaled indacaterol in healthy Chinese volunteers. Eur J Drug Metab Pharmacokinet.2015;40(2):203-8. doi:10.1007/s13318-014-0197-6MedlinePlus.Albuterol oral inhalation.Sellers WFS.Inhaled and intravenous treatment in acute severe and life-threatening asthma.Brit J Anaesth.2013;10(2):183-90. doi:10.1093/bja/aes444Kitaguchi Y, Fujimoto K, Komatsu Y, Hanaoka M, Honda T, Kubo K.Additive efficacy of short-acting bronchodilators on dynamic hyperinflation and exercise tolerance in stable COPD patients treated with long-acting bronchodilators.Respir Med. 2013;107(3):394-400. doi:10.1016/j.rmed.2012.11.013Rasmussen LK, Schuette J, Spaeder MC.Albuterol use in children hospitalized with human metapneumovirus respiratory infection.Int J Pediatr. 2016;2016:7021943. doi:10.1155/2016/7021943Teva Pharmaceutical.ProAir (albuterol sulfate) inhalation aerosol.Eltonsy S, Kettani FZ, Blais L.Beta2-agonists use during pregnancy and perinatal outcomes: a systematic review.Respir Med.2014;108(1):9-33. doi:10.1016/j.rmed.2013.07.009Da Silva D, Jacinto T.Inhaled β-agonists in asthma management: an evolving story.Breathe (Sheff). 2016;12(4):375-7. doi:10.1183/20734735.017116Magee JS, Pittman LM, Jette-Kelly LA.Paradoxical bronchoconstriction with short-acting beta agonist.Am J Case Rep. 2018;19:1204-7. doi:10.12659/AJCR.910888Aljaafareh A, Valle JR, Lin YL, Kuo YF, Sharma G.Risk of cardiovascular events after initiation of long-acting bronchodilators in patients with chronic obstructive lung disease: A population-based study.SAGE Open Med. 2016;4:2050312116671337. doi:10.1177/2050312116671337American Academy of Allergy, Asthma & Immunology.Inhaled asthma medications.
GlaxoSmithKline.Ventolin HFA (albuterol sulfate) inhalation aerosol.
Sunovion Pharmaceuticals.Xopenex HFA (levalbuterol tartrate) inhalation aerosol, for oral inhalation use.
Billington CK, Penn RB, Hall IP.β Agonists.Handb Exp Pharmacol. 2017;237:23-40. doi:10.1007/164_2016_64
Almadhoun K, Sharma S.Bronchodilators. In: StatPearls.
Jiang J, Li L, Yin H, et al.Single- and multiple-dose pharmacokinetics of inhaled indacaterol in healthy Chinese volunteers. Eur J Drug Metab Pharmacokinet.2015;40(2):203-8. doi:10.1007/s13318-014-0197-6
MedlinePlus.Albuterol oral inhalation.
Sellers WFS.Inhaled and intravenous treatment in acute severe and life-threatening asthma.Brit J Anaesth.2013;10(2):183-90. doi:10.1093/bja/aes444
Kitaguchi Y, Fujimoto K, Komatsu Y, Hanaoka M, Honda T, Kubo K.Additive efficacy of short-acting bronchodilators on dynamic hyperinflation and exercise tolerance in stable COPD patients treated with long-acting bronchodilators.Respir Med. 2013;107(3):394-400. doi:10.1016/j.rmed.2012.11.013
Rasmussen LK, Schuette J, Spaeder MC.Albuterol use in children hospitalized with human metapneumovirus respiratory infection.Int J Pediatr. 2016;2016:7021943. doi:10.1155/2016/7021943
Teva Pharmaceutical.ProAir (albuterol sulfate) inhalation aerosol.
Eltonsy S, Kettani FZ, Blais L.Beta2-agonists use during pregnancy and perinatal outcomes: a systematic review.Respir Med.2014;108(1):9-33. doi:10.1016/j.rmed.2013.07.009
Da Silva D, Jacinto T.Inhaled β-agonists in asthma management: an evolving story.Breathe (Sheff). 2016;12(4):375-7. doi:10.1183/20734735.017116
Magee JS, Pittman LM, Jette-Kelly LA.Paradoxical bronchoconstriction with short-acting beta agonist.Am J Case Rep. 2018;19:1204-7. doi:10.12659/AJCR.910888
Aljaafareh A, Valle JR, Lin YL, Kuo YF, Sharma G.Risk of cardiovascular events after initiation of long-acting bronchodilators in patients with chronic obstructive lung disease: A population-based study.SAGE Open Med. 2016;4:2050312116671337. doi:10.1177/2050312116671337
American Academy of Allergy, Asthma & Immunology.Inhaled asthma medications.
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