Key takeaways

  • Short-acting bronchodilators offer quick relief of respiratory symptoms, with effects lasting from 30 minutes to several hours. They are often used as a rescue medication.
  • Long-acting bronchodilators help manage symptoms for 12 to 24 hours and are typically used as a daily maintenance treatment to improve lung function and prevent COPD flares.
  • Your doctor may choose to prescribe either type or both types of medication, depending on how advanced your COPD is.

There are several inhaled medications like albuterol, levalbuterol, ipratropium, and those with combination formulations, including ipratropium/albutarol (duoneb), that can be used to help rapidly control symptoms.

These short-acting bronchodilators span different classifications, offer unique benefits and side effect profiles, and come in different formulations, such as dry powder inhalers, nebulized form, or meter-dosed inhalers.

They are known to provide relief in some cases for less than an hour and in some cases for up to half the day. The benefit of these short-acting beta-agonists or short-acting muscarinic agonists, as they are classified, is the quick onset, but the drawback is the short effect time.

If someone with COPD has mild or intermittent symptoms, a short-acting inhaler or nebulized medication can be used effectively as a stand-alone “maintenance” treatment. Alternatively, in cases where other inhaled medications for COPD are not controlling symptoms, these short-acting bronchodilators can provide rapid symptom control when used on an as-needed basis.

It’s common for patients to have a prescription for a short-acting bronchodilator as a first-line medication when they have a COPD diagnosis or when a flare is occurring.

These medications are generally used only once or twice per day and are not recommended for use on an as-needed basis.

It is common for providers to start patients on a long-acting beta-agonist and a long-acting muscarinic antagonist, such as tiotropium and olodaterol, for maintenance therapy, as these help improve lung function and reduce exacerbations that result in hospital admissions. Other long-acting inhaled medications include revefenacin and umeclidium, to name a few.

A combination of three long-acting inhaled medications, such as budesonide/glycopyrrolate/formoterol, is usually considered when the COPD is more advanced or there are symptoms and diagnostic tests that make combining the medications a more effective treatment strategy.

Typically, a short-acting bronchodilator is also given to be used as a “rescue” medication when symptoms become uncontrolled.

The main differences between these bronchodilators are the onset of symptom relief and the duration of effectiveness. Short-acting bronchodilators last between 30 minutes and 6 to 7 hours, and long-acting bronchodilators last between 12 and 24 hours.

If symptoms and diagnostic tests show that the COPD is on the milder side, short-acting bronchodilators may be the only medication needed to maintain control. However, if the short-acting medications are not controlling the symptoms or if the diagnostic tests show more advanced COPD, long-acting medications may be indicated.

It is very common for patients to use long-acting bronchodilators alongside intermittently dosed short-acting bronchodilators to gain full control of symptoms.

Dr. Nick Villalobos is an ABMS board certified internist, pulmonologist, and clinical assistant professor. His focuses include medical education, point-of-care ultrasound/echocardiography, occupational lung disease, and pulmonary vascular diseases.