Short-acting beta-agonists: Uses, common brands, and safety info

Asthma causes swelling and narrowing of the airways. When allergens or other irritants enter the lungs of people with asthma, symptoms can be triggered. These symptoms can include difficulty breathing, wheezing, cough, and chest tightness. About 25 million people in the United States have asthma—8% of adults and 7% of children.  

Short-acting beta-agonists, also known as SABAs or short-acting beta2-agonists, are the treatment of choice for acute treatment of asthma exacerbations and symptoms, as well as for prevention of exercise-induced asthma. SABAs are also frequently used as a combination product with another inhaled medication for people with chronic obstructive pulmonary disease (COPD). SABAs are commonly inhaled via an inhaler (metered-dose inhaler or dry powder inhaler) or nebulizer solution. The benefit of inhaled medications is that these drugs are effective and do not have many systemic adverse effects. 

This article will discuss the uses, common brand names, and safety information of SABAs.

Other short-acting beta-agonists

In addition to the dosage forms mentioned in the table above, albuterol is also available as an oral syrup. 

In 2010, the FDA removed several inhalers from the market, and several of them were short-acting beta-agonists. These SABA inhalers are no longer commercially available. 

• Alupent Inhalation Aerosol (metaproterenol)

• Maxair Autohaler (pirbuterol)

Terbutaline is another short-acting beta-agonist. It is still on the market, however, it is rarely used due to its 2011 safety warnings. 

Combination drugs that contain a SABA include:*

• Combivent Respimat inhaler (ipratropium/albuterol)

• DuoNeb inhalation solution (ipratropium/albuterol)

*This article focuses on single-ingredient SABAs; combination products are listed for reference only. 

What are short-acting beta-agonists?

Have you ever heard of a rescue inhaler? A rescue inhaler is a short-acting beta-agonist (SABA), which works fast to provide quick relief from an asthma attack. SABAs are also part of a larger drug class known as bronchodilators. Bronchodilators help to open up the airways in the lungs. Bronchodilators can be short-acting or long-acting. This article focuses on short-acting beta-agonists. Short-acting beta-agonists work fast—within 15 to 20 minutes—to help symptoms like shortness of breath and wheezing. A SABA is often prescribed to use as needed for the relief of asthma symptoms. People with exercise-induced asthma also use a SABA before exercising to prevent persistent asthma symptoms. 

SABAs are approved by the U.S. Food and Drug Administration and are available by prescription. 

Short-acting beta-agonists are often prescribed in combination with other asthma medication(s), such as:

• A long-acting beta-agonist (LABA, or long-acting beta2-agonist) such as salmeterol or formoterol—a LABA must always be prescribed with an inhaled steroid, either as 2 separate products or as a combination product 

• An inhaled corticosteroid such as Flovent HFA (fluticasone) or Pulmicort Flexhaler (budesonide)

• An anticholinergic inhaler such as long-acting Spiriva (tiotropium) 

How do short-acting beta-agonists work?

Short-acting beta-agonists work by relaxing smooth muscles around the airways. This helps make it easier to breathe and relieves symptoms of asthma. 

What are short-acting beta-agonists used for?

SABAs are commonly used for:

• Treatment or prevention of bronchospasm (tightening of the airways) in patients with reversible obstructive airway disease (asthma)

• Prevention of exercise-induced bronchospasm

• Relief of symptoms in patients with chronic obstructive pulmonary disease (COPD)

What are the types of short-acting beta-agonists?

Most short-acting beta-agonists are inhaled by one of the following methods. There are some exceptions, such as oral syrup or tablets, but the most common delivery method is inhalation. 

Metered-dose inhalers

A metered-dose inhaler, or MDI, is a handheld inhaler. It uses a propellant to deliver the medication into the lungs. MDIs are portable and convenient. Some people, especially children, use a spacer with the MDI. A spacer attaches to the MDI and helps deliver the drug more effectively. Examples of MDIs include ProAir HFA, Proventil HFA, Ventolin HFA, and Xopenex HFA. 

Dry powder inhalers

Dry powder inhalers (DPIs) contain the medication inside a capsule or blister, which is punctured before use. A DPI is breath-activated. DPIs are portable and convenient, although people with a severe milk protein allergy cannot use DPIs. Examples of dry powder inhalers are ProAir RespiClick and ProAir Digihaler. 

Nebulizer solution

A nebulizer machine turns the inhaled medication into an aerosol that can be delivered into the lower airway. Examples of nebulizer solutions include albuterol nebulizer solution or levalbuterol nebulizer solution. Nebulizers are the least portable and most time-consuming but offer an advantage for those who cannot use an inhaler, such as very young children.  

Who can take short-acting beta-agonists?

Before taking a SABA, review your medical history, allergies to medications, and any medications you currently take, with your healthcare provider. This includes Rx and OTC drugs, vitamins, and supplements.

Men

Men can take a SABA, provided that it is needed for an approved use and that there are no contraindications to the medication’s use. 

Women who are not pregnant or breastfeeding

Women who are not pregnant or breastfeeding can take a SABA, provided that it is needed for an approved use and that there are no contraindications to the medication’s use. 

Women who are pregnant or breastfeeding

Women who are pregnant, planning to become pregnant, or breastfeeding, should consult their healthcare provider regarding the use of a SABA. 

Children

Children can take a SABA, depending on age and dosage form. For example, an albuterol inhaler can be used in children 4 years and older, while the nebulizer solution can be used in children 2 years and older. However, SABAs are often prescribed off-label in younger children. 

Older adults 

The prescribing information for SABAs recommends cautious dosing in older adults, starting at the lower end of the dosing range, to account for any possible problems with the liver, heart, or kidneys. Because all SABAs are eliminated by the kidney, and older adults are more likely to have kidney problems, kidney function should be monitored. 

Are short-acting beta-agonists safe?

Recalls

No recalls found.

Restrictions

SABAs are not appropriate for everyone. People should not take a SABA if they are allergic to any drug in the SABA drug class. Also, dry powder inhalers should be avoided in patients with a severe allergy to milk protein (these include the ProAir HFA Digihaler and ProAir RespiClick). 

In some cases, a SABA may be prescribed with caution if the healthcare provider determines that benefits outweigh risks. These groups of people include those who are/who have:

• Taken a monoamine oxidase inhibitor (MAOI) drug or a tricyclic antidepressant in the last 14 days

• Ischemic heart disease

• Hypertension (high blood pressure)

• Arrhythmias

• Hypokalemia (low potassium levels)

• Diabetes

• Seizure disorder

• Hyperthyroidism

• Unusually responsive to sympathomimetic amines

• Kidney problems

Are short-acting beta-agonists controlled substances?

No, short-acting beta-agonists are not controlled substances.

Common short-acting beta-agonists side effects

The most common side effects of SABAs are:

• Upper respiratory infection symptoms/throat irritation/cough

• Bad taste in the mouth

• Tremor

• Dizziness 

• Nervousness

• Nausea or vomiting

• Headache 

• Palpitations

• Tachycardia (fast heart rate)

• Pain 

• Weakness 

• Chest pain

Serious side effects can occur. Serious side effects may include:

• Hypersensitivity or anaphylaxis: Symptoms of a severe allergic reaction may include hives, difficulty breathing, and swelling of the face, lips, neck, or throat, and require emergency medical attention. 

• Paradoxical bronchospasm: Get emergency medical help or call your doctor right away if you have wheezing, choking, or breathing problems after using a SABA.

• Changes in blood pressure: Get emergency medical help or call your doctor right away if you have symptoms of low blood pressure such as dizziness—or symptoms of high blood pressure such as a severe headache, chest pain, or shortness of breath. 

• Chest pain: Get emergency medical help or call your doctor right away if you have chest pain. 

• Cardiac arrest: Get emergency medical help or call your doctor right away if you have chest pain, shortness of breath, fainting or dizziness, fatigue, or racing heartbeat. 

• Arrhythmia: Call your doctor right away if you have chest pain, a fast heart rate, a pounding heartbeat, or feel a flutter in the chest. 

• Low potassium levels: Call your doctor right away if you have leg cramps, constipation, irregular heartbeat, numbness or tingling, or if your muscles feel weak. 

• Hyperglycemia (high blood sugar): Call your doctor right away if you have increased thirst or urination, dry mouth, or if your breath smells like fruit. 

This is not a full list of side effects and other side effects may occur. Before taking a SABA, talk to your doctor about what side effects to expect and how to address them.

How often should I use my short-acting beta-agonist?

Your healthcare provider will establish a treatment plan that often requires several medications. In addition to a SABA, other medications will help to prevent symptoms. Usually, if you are using your SABA or “rescue” medicine more than 2 or 3 times a week (unless you are using it pre-exercise), then you should check in with your healthcare provider to see if you need a change to your regimen.

How much do short-acting beta-agonists cost?

The price of a SABA varies based on your insurance plan or Medicare prescription coverage. You can contact your insurance plan for details of your coverage, or ask your pharmacist to process your prescription. You can always use a free SingleCare card to save money on your prescriptions—our customers save up to 80% on their medications, and you can use the coupon for refills, too. A ProAir HFA prescription usually costs about $93 for one inhaler, but a ProAir HFA SingleCare card can bring the price of a generic ProAir HFA inhaler down to as low as $13.