Inhaled adrenergic bronchodilators: historical development and clinical application

The adrenergic bronchodilators that have been developed for oral inhalation represent successive refinement in terms of receptor specificity and duration of action. Beta agonist bronchodilators have durations of 4-6 hours, or, in the case of salmeterol, of up to 12 hours, offering convenient dosing. Inhalation of the aerosol formulations targets the lung directly. The release of levalbuterol now provides an agent with a single isomer active on beta-2 receptors. The currently available agents offer clinicians and patients with reversible obstructive lung disease a choice of sophisticated drugs for airway smooth muscle relaxation. Although improvements in the drugs have reduced adverse effects and beta agonists are considered safe, concerns persist about the effect of beta agonists in asthma. An improved understanding of asthma pathophysiology may lead to more appropriate use of beta agonists in asthma.