Focus on Inhaled β 2 ‐Agonists: Efficacy, Safety, and Patient Preference

Inhaled β 2 ‐agonists are a standard therapy for patients with obstructive lung diseases. Clinical efficacy, safety, and patient preference are important reasons that these agents have become so widely used. In addition to significant bronchodilatory effects, β 2 ‐agonists have potentially clinically important effects on the lungs including promotion of mucociliary clearance and effects on inflammation. Albuterol, levalbuterol, and salmeterol are the most frequently used agents in the United States. In the acute care setting, short‐acting β 2 ‐agonists are standard therapy for obstructive lung disease whereas the use of long‐acting β 2 ‐agonists in this setting is less clear. Potential clinical issues regarding the use of β 2 ‐agonists in the acute care setting include type of inhalational delivery method used, such as metered‐dose inhaler versus nebulization, use of heliox instead of oxygen, safety issues, and selection of agent. The role of the more recently available β 2 ‐agonists—levalbuterol (the R‐isomer of albuterol) and formoterol—are evolving. Levalbuterol may have clinical and economic advantages in the emergency department setting, however, additional research is necessary to validate this observation.