Key messages

• There is a selection of b-adrenergic agonists commonly used as bronchodilators that differ in their length of action and b-receptor selectivity.

• The preferred method of administering b-adrenergic agonists is the inhaled route. The intravenous route is reserved for those with a suboptimal response to the inhaled route. The most common cause of suboptimal response to therapy is inadequate dosing.

• Anticholinergic drugs are best employed with b-adrenergic agonists for acute bronchospasm, and are particularly effective in patients with chronic obstructive airways disease.

• Theophylline has a synergistic action with b-adrenergic agonists, and can be delivered intravenously as aminophylline.

• Inhalational anesthetic agents (halothane, enflurane, isoflurane, sevoflurane) have demonstrable bronchodilating activity. Halothane is the most potent, but has more side-effects in the presence of high levels of background sympathomimetic activity.

• Ketamine has been used as an intravenous infusion with good effect in a small number of case reports.

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