Beta2-Agonists for Chronic Obstructive Pulmonary Disease (COPD)

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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 placebo :

  • 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 alone.

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 tremors.
  • Nervousness.
  • Increased or irregular heartbeat (palpitations).

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 Staff

Primary 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 ofMarch 25, 2017