Table of ContentsView All
View All
Table of Contents
What They Do
How They Work
Effectiveness
Side Effects
Guidelines for Use
How to Take & Store
Additions & Alternatives
Beta2 (ß2)-agonist medications are a type of inhaled bronchodilator used totreat asthma. In thepathophysiology of asthma, tightened airways cause wheezing, chest tightness, shortness of breath, and chronic cough.ß2-agonists relax the smooth muscles of the airways to relieve these symptoms.
Both short-acting ß2-agonists (SABAs) and long-acting ß2-agonists (LABAs) play important—but different—roles in asthma management. There is also a difference between LABAs that are quick-acting and those that are not quick-acting (it is NOT safe to use these as a reliever).
Formoterol (found in Symbicort, Dulera, and as a generic) is an example of a quick-acting LABA. Unfortunately, salmeterol (found in Advair and other combo drugs in the United States) is not quick-acting and is not safe for use as a reliever medication.
Verywell / Hilary Allison
What Do ß2-Agonists Do?
SABAs work quickly and are used to haltasthma attacksand otherasthma symptomsright away. The most common SABA is albuterol. SABAs are often called rescue inhalers.
LABAs are daily medications used to control chronic symptoms and prevent asthma attacks. Studies show they can:
LABAs are also used to preventexercise-induced asthma.
LABAs aren’t used alone, though. They come incombination medicationsthat also include aninhaled corticosteroid (ICS).
In addition to asthma, both SABAs and LABAs are used to treatchronic obstructive pulmonary disease (COPD).
The Food and Drug Administration (FDA) has approved two SABAs for treating asthma, both of which are available in generic form as well as under brand names:
ICS/LABA combination inhalers include:
ß2-agonists mimic two hormones—epinephrine and norepinephrine—and attach to ß2 receptors in the muscles of your airways. These receptors are found in your lungs, as well as the digestive tract, uterus, and some blood vessels.
When this occurs, it starts a chemical chain reaction that ends with the smooth muscles relaxing.For those with asthma, this means less bronchoconstriction.
ß2-agonists open your airways, but they don’t address the inflammation at the root of asthma symptoms and exacerbations (attacks). ICSs, however, are powerful anti-inflammatories.
Interestingly, the Chinese appear to have used beta-agonists to relax airways about 5,000 years ago, when they discovered that a plant calledma huangimproved breathing. Scientists later found that the plant contains ephedrine.
Asthma Doctor Discussion GuideGet our printable guide for your next doctor’s appointment to help you ask the right questions.Download PDFEmail AddressSign UpThank you, {{form.email}}, for signing up.There was an error. Please try again.
Get our printable guide for your next doctor’s appointment to help you ask the right questions.
Download PDF
Email AddressSign UpThank you, {{form.email}}, for signing up.There was an error. Please try again.
Sign Up
Thank you, {{form.email}}, for signing up.
There was an error. Please try again.
ß2-agonist medications are considered highly effective at relieving symptoms of asthma. Modern ß2-agonists are the result of more than a century of intensive research into asthma treatments.
SABAs provide almost instant relief of symptoms, but the effect only lasts for between four and six hours.
LABAs can keep the muscles relaxed for longer (between five and 12 hours, depending on the frequency of use) but are not anti-inflammatories like ICSs. Most LABAs also take some time to open up the airways, and they cannot replace the use of SABAs when someone is feeling acute asthma symptoms.
Side effects of the various ß2-agonists are similar and include:
Warning RemovedIn 2006, the FDA gave LABAs a black-box warning regarding an increased risk of asthma-related death with use. The FDA rescinded the warning in 2018 after reviewing data from four large clinical trials that showed LABAs didn’t increase the risk of serious side effects over treatment with ICS alone.
Warning Removed
In 2006, the FDA gave LABAs a black-box warning regarding an increased risk of asthma-related death with use. The FDA rescinded the warning in 2018 after reviewing data from four large clinical trials that showed LABAs didn’t increase the risk of serious side effects over treatment with ICS alone.
Standard asthma treatment involves a step-wise approach to medication use:
LABAs are typically avoided until after you’ve tried an ICS because they are less effective. The fact that LABAs are believed to have a greater risk of side effects when used alone than ICSs when used alone plays a part in this as well.
Updated Recommendations
In 2019, the Global Initiative for Asthma (GINA) released revised guidelines recommending that most people with asthma use a single inhaler—ICS or combination ICS+LABA—as both preventive treatment and a rescue inhaler.
The organization no longer recommends treatment with SABAs alone because:
In more practical terms, GINA is saying that you no longer have to juggle a rescue inhaler and your preventive medication. If symptoms flare, you simply need to take an additional dose of the ICS or ICS+quick-acting LABA.
The United States medical community is unlikely to adopt these recommendations because the FDA hasn’t approved these medications for as-needed use.
Conditions That Up Your COVID-19 Risk
How to Take and Store
When using a new inhaler, or one that’s gone unused for a while, you’ll need to prime it to ensure you get the proper dosage:
If you’ve used the inhaler recently, you shouldn’t need to do this. Just follow the steps recommended for use of all bronchodilators, which include ensuring your lungs are empty before you inhale the medication, holding it in for 10 seconds before exhaling, and rinsing your mouth out with water when you’re done.
Once a week, rinse your inhaler’s plastic case and allow it to dry completely. Don’t submerge the cartridge in water or use cleaning products on your inhaler.
For safety purposes, keep your inhaler:
Never Miss a DoseRequest a refill from your pharmacy or healthcare provider’s office before yourinhaler expires or runs outso you can treat your next asthma attack right away.
Never Miss a Dose
Request a refill from your pharmacy or healthcare provider’s office before yourinhaler expires or runs outso you can treat your next asthma attack right away.
Treatment Additions and Alternatives
SABAs are first-line treatments when it comes to rescue inhalers. However, if they don’t provide you with enough relief, a couple of other options are available:
Other than ICSs and LABAs, classes of medications used for long-term asthma control include:
Because inhaled corticosteroids are considered the most effective due to their anti-inflammatory effects, the other types of drugs are all used as add-on therapies in people already taking an ICS.
A Word From Verywell
If your asthma is not adequately managed on your current treatment plan, even if it has already been modified, speak with your healthcare provider.
Remember that your asthma usually isn’t well controlled if:
Discuss whether you need to add another medication to your asthma-control regimen, such as a beta2-agonist.
Why You Need an Asthma Action Plan
9 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.Cleveland Clinic.Asthma symptoms.Smith WG.Beta2-agonists for exercise-induced asthma[published correction appears in Paediatr Child Health; 20(8):466-7].Paediatr Child Health; 19(7):355-356.Barisione G, Baroffio M, Crimi E, Brusasco V.Beta-adrenergic agonists.Pharmaceuticals (Basel). 2010;3(4):1016-1044. Published 2010 Mar 30. doi:10.3390/ph3041016Billington CK, Penn RB, Hall IP.β2 Agonists.Handb Exp Pharmacol. 2017;237:23-40. doi:10.1007/164_2016_64American Academy of Allergy, Asthma & Immunology.AAAAI allergy & asthma medication guide.Cleveland Clinic.Bronchodilators & asthma.Food and Drug Administration.FDA drug safety communication: FDA review finds no significant increase in risk of serious asthma outcomes with long-acting beta agonists (LABAs) used in combination with inhaled corticosteroids (ICS).PulmCCM.Major asthma guideline update: ICS-LABA as-needed replaces albuterol.Global Initiative for Asthma.Pocket guide for asthma management and prevention (for adults and children older than 5 years).
9 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.Cleveland Clinic.Asthma symptoms.Smith WG.Beta2-agonists for exercise-induced asthma[published correction appears in Paediatr Child Health; 20(8):466-7].Paediatr Child Health; 19(7):355-356.Barisione G, Baroffio M, Crimi E, Brusasco V.Beta-adrenergic agonists.Pharmaceuticals (Basel). 2010;3(4):1016-1044. Published 2010 Mar 30. doi:10.3390/ph3041016Billington CK, Penn RB, Hall IP.β2 Agonists.Handb Exp Pharmacol. 2017;237:23-40. doi:10.1007/164_2016_64American Academy of Allergy, Asthma & Immunology.AAAAI allergy & asthma medication guide.Cleveland Clinic.Bronchodilators & asthma.Food and Drug Administration.FDA drug safety communication: FDA review finds no significant increase in risk of serious asthma outcomes with long-acting beta agonists (LABAs) used in combination with inhaled corticosteroids (ICS).PulmCCM.Major asthma guideline update: ICS-LABA as-needed replaces albuterol.Global Initiative for Asthma.Pocket guide for asthma management and prevention (for adults and children older than 5 years).
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.
Cleveland Clinic.Asthma symptoms.Smith WG.Beta2-agonists for exercise-induced asthma[published correction appears in Paediatr Child Health; 20(8):466-7].Paediatr Child Health; 19(7):355-356.Barisione G, Baroffio M, Crimi E, Brusasco V.Beta-adrenergic agonists.Pharmaceuticals (Basel). 2010;3(4):1016-1044. Published 2010 Mar 30. doi:10.3390/ph3041016Billington CK, Penn RB, Hall IP.β2 Agonists.Handb Exp Pharmacol. 2017;237:23-40. doi:10.1007/164_2016_64American Academy of Allergy, Asthma & Immunology.AAAAI allergy & asthma medication guide.Cleveland Clinic.Bronchodilators & asthma.Food and Drug Administration.FDA drug safety communication: FDA review finds no significant increase in risk of serious asthma outcomes with long-acting beta agonists (LABAs) used in combination with inhaled corticosteroids (ICS).PulmCCM.Major asthma guideline update: ICS-LABA as-needed replaces albuterol.Global Initiative for Asthma.Pocket guide for asthma management and prevention (for adults and children older than 5 years).
Cleveland Clinic.Asthma symptoms.
Smith WG.Beta2-agonists for exercise-induced asthma[published correction appears in Paediatr Child Health; 20(8):466-7].Paediatr Child Health; 19(7):355-356.
Barisione G, Baroffio M, Crimi E, Brusasco V.Beta-adrenergic agonists.Pharmaceuticals (Basel). 2010;3(4):1016-1044. Published 2010 Mar 30. doi:10.3390/ph3041016
Billington CK, Penn RB, Hall IP.β2 Agonists.Handb Exp Pharmacol. 2017;237:23-40. doi:10.1007/164_2016_64
American Academy of Allergy, Asthma & Immunology.AAAAI allergy & asthma medication guide.
Cleveland Clinic.Bronchodilators & asthma.
Food and Drug Administration.FDA drug safety communication: FDA review finds no significant increase in risk of serious asthma outcomes with long-acting beta agonists (LABAs) used in combination with inhaled corticosteroids (ICS).
PulmCCM.Major asthma guideline update: ICS-LABA as-needed replaces albuterol.
Global Initiative for Asthma.Pocket guide for asthma management and prevention (for adults and children older than 5 years).
Meet Our Medical Expert Board
Share Feedback
Was this page helpful?Thanks for your feedback!What is your feedback?OtherHelpfulReport an ErrorSubmit
Was this page helpful?
Thanks for your feedback!
What is your feedback?OtherHelpfulReport an ErrorSubmit
What is your feedback?
