Pulmonary Pharmacology

Albuterol

Brand: ProAir, Ventolin, Proventil

Class: SABA

Primary Role: Rescue

MOA: β2 agonist → ↑ cAMP/PKA → ↓ MLCK → bronchodilation

Key Uses: Gold-standard rescue inhaler; acute bronchospasm; EIB prevention

ADR: Tachycardia, tremor, hypokalemia; overuse without ICS can worsen control

Levalbuterol

Class: SABA

Brand: Xopenex

Primary Role: Rescue

MOA: β2 agonist

Key Use: Purified R-isomer; fewer β1 effects

ADR: Similar SABA ADRs: tachycardia, tremor, hypokalemia

Terbutaline

Brand: Brethine

Class: SABA

Primary Use: Rescue / severe exacerbation support

MOA: β2 agonist

Key Use: SubQ or oral; important in status asthmaticus; onset about 5–15 min, duration 4–6 hr

ADR: β-agonist ADRs; cardiac caution

Salmeterol

Brand: Serevent

Class: LABA

Primary Use: Controller

MOA: β2 agonist

Key Use: Slow onset; maintenance only

ADR: Do not use without ICS; not rescue

Formoterol

Brand: Perforomist

Class: LABA

Primary Use: Controller; SMART with ICS

MOA: β2 agonist

Key Use: Fast-onset LABA; can be used in SMART when paired with ICS

ADR: Do not use without ICS as asthma monotherapy

Ipratropium

Brand: Atrovent; Combivent Respimat, DuoNeb (with albuterol)

Class: SAMA

Primary Use: Rescue add-on

MOA: M3 blockade → ↓ Gq/PLC/Ca2+ → ↓ Ca-CaM/MLCK

Key Use: Off-label / ER add-on in acute asthma; decreases mucus

ADR: Dry mouth, bitter taste, urinary retention, glaucoma worsening

Tiotropium

Brand: Spiriva Respimat

Class: LAMA

Primary Use: Controller add-on

MOA: M3 blockade

Key Use: Key asthma maintenance antimuscarinic; slower onset, ~24 hr duration

ADR: Dry mouth most common; caution in glaucoma/BPH/urinary retention

Theophylline

Brand: Theo-24, Elixophyllin, Theochron

Class: methylxanthine

Primary Use: Alternative/add-on controller

MOA: PDE inhibition → ↑ cAMP; adenosine receptor blockade; low-dose HDAC2 activation

Key Use: Useful for nocturnal asthma; steroid-sensitizing concept

ADR: GI upset, tachyarrhythmias, seizures; smoking induces CYP1A2 so higher doses may be needed

Aminophylline

Class: methylxanthine

Primary Use: Related methylxanthine

MOA: Theophylline complex / salt form

Key Use: Useful for nocturnal asthma; steroid-sensitizing concept

ADR: GI upset, tachyarrhythmias, seizures; smoking induces CYP1A2 so higher doses may be needed

QVAR, Pulmicort, Alvesco, Flovent HFA, Arnuity Ellipta, Asmanex

Class: ICS

Primary Use: Controller

MOA: Broad anti-inflammatory gene regulation; ↑ lipocortin-1 → inhibits PLA2; ↓ cytokines; ↑ β2 receptor responsiveness

Key Use: Chief preventive/controller therapy in asthma; delayed effect; not rescue

ADR: Thrush; rinse mouth and spit; ciclesonide is a prodrug and may reduce local thrush risk

Beclomethasone

Brand: QVAR

Class: ICS

Primary Use: Controller

MOA:

Key Use: Persistent asthma

ADR: Thrush / local ICS effects

Budesonide

Brand: Pulmicort

Class: ICS

Primary Use: Controller

MOA:

Key Use: One of the most commonly prescribed ICS

ADR: Thrush / local ICS effects

Ciclesonide

Brand: Alvesco

Class: ICS

Primary Use: Controller

MOA: ICS prodrug

Key Use: Prodrug; may reduce oropharyngeal adverse effects

ADR: Thrush still possible, though local risk may be lower

Fluticasone

Brand: Flovent HFA, Arnuity Ellipta

Class: ICS

Primary Use: Controller

MOA: ICS

Key Use: Commonly prescribed ICS

ADR: Thrush / local ICS effects

Mometasone

Brand:

Class:

Primary Use:

MOA:

Key Use:

ADR: Thrush / local ICS effects

Montelukast

Brand: Singulair

Class: LTRA

Primary Use:

MOA:

Key Use:

ADR:

Zafirlukast

Class: Leukotriene Receptor Antagonist

Primary Use: Controller

MOA:

Key Use:

ADR:

Cromolyn

Brand: Generic neb solution

Class: Mast Cell Stabilizer

Primary Use: Prophylaxis only

MOA: Prevents mast cell degranulation and mediator release

Key Use: No bronchodilation; prophylactic only

ADR: Local irritation, cough, throat irritation; not for acute attacks

Omalizumab

Brand: Xolair

Class: anti-IgE

Primary Use: Biologic controller

MOA: Binds free IgE

Key Use: Moderate-severe allergic asthma; steroid-sparing

ADR: Anaphylaxis warning; carry epinephrine autoinjector; not rescue

Mepolizumab

Brand: Nucala

Class: anti-IL-5

Primary Use: Biologic controller

MOA: Binds IL-5

Key Use: Severe eosinophilic asthma

ADR: Herpes zoster caution; treat helminths first; not rescueReslizumab

Reslizumab

Brand: Cinqair

Class: anti-IL-5

Primary Use: Biologic controller

MOA: Binds IL-5

Key Use: Severe eosinophilic asthma

ADR: Anaphylaxis warning; not rescue

Benralizumab

Brand: Fasenra

Class: anti-IL-5Rα

Primary Use: Biologic controller

MOA: Blocks IL-5 receptor alpha and drives eosinophil depletion via ADCC

Key Use: Severe eosinophilic asthma; strong eosinophil-depletion pearl

ADR: Rare anaphylaxis; not rescue; do not abruptly stop steroids

Dupilumab

Brand: Dupixent

Class: anti-IL-4Rα

Primary Use: Biologic controller

MOA: Blocks IL-4 / IL-13 signaling

Key Use: Type 2 inflammatory asthma; IgE + mucus axis pearl

ADR: Injection reactions, conjunctivitis/keratitis, eosinophilia; not rescue

Tezepelumab

Brand: Tezspire

Class: anti-TSLP

Primary Use: Biologic controller

MOA: Blocks TSLP, an upstream epithelial alarmin

Key Use: Upstream type-2 inflammation control

ADR: Not rescue; biologic-type hypersensitivity monitoring applies