Beta2-Agonists for Chronic Obstructive Pulmonary Disease (COPD)

Covers beta2-agonists for COPD. Looks at bronchodilator medicines to relax and enlarge airways in the lungs, making breathing easier. Lists generic and brand names such as albuterol (Proventil). Includes how well they work and side effects.

Beta2-Agonists for Chronic Obstructive Pulmonary Disease (COPD)



Generic Name Brand Name
albuterol (short-acting) Proair, Proventil, Ventolin
arformoterol (long-acting) Brovana
formoterol (long-acting) Foradil, Perforomist
indacaterol Arcapta Neohaler
levalbuterol (short-acting) Xopenex
metaproterenol (short-acting)  
salmeterol (long-acting) Serevent
terbutaline (short-acting)  

Long-acting beta2-agonist and anticholinergic combination

Generic Name Brand Name
vilanterol and umeclidinium Anoro Ellipta

Long-acting beta2-agonist and corticosteroid combination

Generic Name Brand Name
formoterol and budesonide Symbicort
salmeterol and fluticasone Advair
vilanterol and fluticasone Breo Ellipta

Short-acting beta2-agonist and anticholinergic combination

Generic Name Brand Name
albuterol and ipratropium Combivent, DuoNeb

Beta2-agonists are available in metered-dose
inhaler (MDI),
dry powder inhaler (DPI), nebulizer, pill, injected, and syrup forms. Some
beta2-agonists may be available in multiple forms. Your doctor will help you
decide which form is best for you.

There are two types of
beta2-agonists: short-acting and long-acting. The short-acting type relieves
symptoms and the long-acting type helps prevent breathing problems.
Short-acting beta2-agonists are used for treating stable COPD in a person whose
symptoms come and go (intermittent symptoms). Long-acting beta2-agonists are
effective and convenient for preventing and treating COPD in a person whose
symptoms do not go away (persistent symptoms).

How It Works

Beta2-agonists are
a type of bronchodilator. This means that they relax and
enlarge (dilate) the airways in the lungs, making breathing easier.

Why It Is Used

Beta2-agonists are considered
first-line therapy for the treatment of stable
chronic obstructive pulmonary disease (COPD) with
symptoms that come and go (intermittent symptoms). They are used for both
short- and long-term relief of symptoms.

Beta2-agonists also may
be used before exercise to reduce breathing difficulties.

Arformoterol, formoterol, or salmeterol may be taken to prevent shortness
of breath or coughing that may keep you from exercising.

How Well It Works

Studies show that inhaled
beta2-agonists are effective in treating symptoms of COPD and improving lung
function as measured by tests (spirometry).They also reduce the
number of
COPD exacerbations.

Compared to

  • Inhaled short-acting beta2-agonists are
    effective in treating a person whose symptoms are rapidly getting worse (COPD exacerbation) and improving lung function and shortness of breath in
    stable COPD.
  • Inhaled long-acting beta2-agonists improve lung
    function and improve symptoms such as shortness of breath.

Results vary from one person to the next. For some people
with COPD, beta2-agonist medicines make breathing much easier. For others, they
do not help.

Your doctor may prescribe more than one type of medicine to help your lung function.
For example, using a beta2-agonist:

  • With an anticholinergic may help your lung
    function more than using either medicine alone.
  • With an inhaled corticosteroid may result in improved shortness of
    breath and less use of relief medicine compared to
    placebo or compared to either medicine used

To help reduce the risk of side effects, your doctor may prescribe more than one medicine rather than raising the dose of your existing medicine.

Side Effects

All medicines have side effects. But many people don’t feel the side effects, or they are able to deal with them. Ask your pharmacist about the side effects of each medicine you take. Side effects are also listed in the information that comes with your medicine.

Here are some important things to think about:

  • Usually the benefits of the medicine are more important than any minor side effects.
  • Side effects may go away after you take the medicine for a while.
  • If side effects still bother you and you wonder if you should keep taking the medicine, call your doctor. He or she may be able to lower your dose or change your medicine. Do not suddenly quit taking your medicine unless your doctor tells you to.

Call your doctor right away if:

  • Your wheezing gets worse after taking one of these medicines.

Common side effects of these medicines include:

  • Headache.
  • Anxiety.
  • Nausea.
  • Muscle
  • Nervousness.
  • Increased or irregular heartbeat

Side effects are much more likely to
occur when you take this medicine as a pill or injection than when you use the
inhaled form.

See Drug Reference for a full list of side
effects. (Drug Reference is not available in all systems.)

What To Think About

While short-acting beta2-agonists
may be the first choice for treating symptoms of mild COPD that come and go
(intermittent symptoms), anticholinergics typically are regarded as the
first-line treatment for persistent symptoms, in most cases of COPD.

Inhalation is the preferred method of taking beta2-agonists. This method
reduces the chance of side effects and makes the medicine more effective. Pills
and injections are reserved for those who cannot use an inhaler or nebulizer.

Nebulizers normally are no better at
delivering beta2-agonists deep into the lungs than a properly used metered-dose
inhaler. Sometimes your doctor may prescribe a nebulizer. Although a nebulizer
can deliver a very large dose of medicine, it also may increase side effects of
the medicine.

Most doctors recommend that everyone using an
inhaler also use a
spacer. Use of a spacer is especially important when
using an inhaler containing a steroid medicine. But you should not use a dry
powder inhaler (DPI) with a spacer.

Taking medicine

Medicine is one of the many tools your doctor has to treat a health problem. Taking medicine as your doctor suggests will improve your health and may prevent future problems. If you don’t take your medicines properly, you may be putting your health (and perhaps your life) at risk.

There are many reasons why people have trouble taking their medicine. But in most cases, there is something you can do. For suggestions on how to work around common problems, see the topic Taking Medicines as Prescribed.

Advice for women

If you are pregnant, breastfeeding, or planning to get pregnant, do not use any medicines unless your doctor tells you to. Some medicines can harm your baby. This includes prescription and over-the-counter medicines, vitamins, herbs, and supplements. And make sure that all your doctors know that you are pregnant, breastfeeding, or planning to get pregnant.


Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It’s also a good idea to know your test results and keep a list of the medicines you take.

Complete the new medication information form (PDF) ( What is a PDF document? ) to help you understand this medication.


Other Works Consulted

  • Department of Veterans Affairs, Department of Defense (2014). VA/DoD clinical practice guideline for the management of chronic obstructive pulmonary disease. U.S. Department of Veterans Affairs. :// Accessed June 23, 2016.
  • Global Initiative for Chronic Obstructive Lung Disease (2016). Global strategy for diagnosis, management, and prevention of COPD – 2016. Global Initiative for Chronic Obstructive Lung Disease. :// Accessed June 23, 2016.


ByHealthwise StaffPrimary Medical Reviewer E. Gregory Thompson, MD – Internal Medicine Adam Husney, MD – Family Medicine Specialist Medical Reviewer Hasmeena Kathuria, MD – Pulmonology, Critical Care Medicine, Sleep Medicine

Current as ofDecember 6, 2017