Bronchodilators: Precautions

Bronchodilators come with patient instructions. Be sure to carefully read them before using the medicine. If there is any confusion about how to use the medicine, check with the physician or pharmacist. Always use these medicines exactly as directed. Taking larger than recommended doses or using the medicine too often can lead to serious side effects and even death.

If symptoms do not improve or if they get worse after using a bronchodilator, call a physician right away.

Although some bronchodilators are available without a physician's prescription, these medicines should not be used unless a physician has diagnosed the patient's condition as asthma.

Some asthma experts believe that the overuse of bronchodilators can cause asthma to get worse. They advise patients and their physicians to consider controlling asthma with anti-inflammatory drugs including inhaled steroids such as beclomethasone dipropionate (Beclovent, Vanceril), flunisolide (AeroBid) or triamcinolone acetonide (Azmacort) Ideally, asthma should be controlled with an inhaled steroid that is used along with the bronchodilator. The more the inhaled steroid steroid controls the inflammation that causes the asthma, the less bronchodilator the patient needs to use because symptoms are under control.

Persons with diabetes should be aware that the bronchodilator epinephrine may raise their blood sugar levels.

Patients who are using an aerosol bronchodilator and an aerosol form of either ipratropium or a corticosteroid such as beclomethasone dipropionate (Beclovent, Vanceril) should use the bronchodilator first, then wait 5 minutes before using the other medicine. Check with a physician before using any other inhaled medications or other asthma medicines. The physician must determine the proper amount of time between doses.

Some bronchodilator products contain sulfites, that trigger an allergic reaction in certain people. Anyone who has a sulfite allergy should read the label carefully or check with a physician or pharmacist before using a bronchodilator. Call a physician immediately if any of these signs of an allergic reaction to sulfite occur:

• bluish coloration of the skin
• flushed or red face or skin
• faintness
• severe dizziness
• increased wheezing or other breathing problems
• skin rash, hives, or itching
• swelling of the face, lips, or eyelids

People with certain medical conditions or who are taking certain other medicines can have problems if they use bronchodilators. Before using these drugs, be sure to let the physician know about any of these conditions:

ALLERGIES. Anyone who has had unusual reactions to any bronchodilator or an inhaled form of any other drug in the past should let his or her physician know before taking the drugs again. The physician should also be told about any allergies to foods, dyes, preservatives, or other substances.

Patients who are allergic to soybeans, soy lecithin, peanuts, or drugs based on atropine should not use the bronchodilator ipratropium (Atrovent).

PREGNANCY. In studies of laboratory animals, some bronchodilators cause birth defects or miscarriage when the animals are given doses many times the usual human dose. Whether these drugs cause such problems in humans in unknown. Any woman who is pregnant or plans to become pregnant should check with her physician before using a bronchodilator.

BREASTFEEDING. Some bronchodilators pass into breast milk. Breastfeeding mothers should check with their physicians before using bronchodilators.

OTHER MEDICAL CONDITIONS. Before using bronchodilators, people with any of these medical problems should make sure their physicians are aware of their conditions:

• glaucoma
• brain damage

• convulsions (seizures)—recently or anytime in the past
• mental illness
• parkinson's disease
• diabetes
• heart or blood vessel diseases
• rapid or irregular heartbeat
• high blood pressure
• overactive thyroid
• enlarged prostate
• obstruction of the neck of the bladder

USE OF CERTAIN MEDICINES. Using bronchodilators with certain other drugs may affect the way the drugs work or may increase the chance of side effects.

— Nancy Ross-Flanigan