Is albuterol a rescue inhaler?

Asthma and chronic obstructive pulmonary disease (COPD) are the 2 most common lung conditions in the United States. They usually require long-term management with medication. Inhalers tend to be a go-to since the medication is released directly into the lungs without much absorption to the rest of the body. This lowers the possibility of side effects and drug interactions.

While the medications can vary, people with asthma or COPD often require a “rescue inhaler” (bronchodilator) to help when they have sudden difficulty breathing. There are several of them on the market, including albuterol and levalbuterol. Read on to learn more about their differences and similarities.

What are the different types of rescue inhalers?

The 2 types of rescue inhalers commonly used in the U.S. are in the same class of drugs, though their active ingredients and inhaler designs differ. They are albuterol and levalbuterol, and there are many different versions. You’ll see “HFA” in the names of some inhalers. It stands for “hydrofluoroalkane” and is a chemical used to send the medication into your lungs.

Albuterol inhalers

  • Proair HFA
  • ProAir Respiclick
  • Accuneb
  • Proventil
  • Ventolin
  • Albuterol (generic)

Levalbuterol inhalers

  • Xopenex
  • Xopenex HFA
  • Levalbuterol (generic)

How do albuterol and levalbuterol inhalers work?

When you breathe, air travels through many different tubes within your lungs, which eventually brings oxygen to your bloodstream. The smallest tubes are called bronchioles. Trouble breathing—which is common in asthma and COPD—is often caused by these the bronchioles squeezing shut (bronchospasm). This can cause:

  • Chest tightening
  • Shortness of breath
  • Wheezing
  • Trouble breathing overall

Albuterol and levalbuterol belong to the class of drugs called beta2-adrenergic agonists that cause the bronchioles to relax and open up, making breathing much easier.

Because albuterol and levalbuterol can be delivered directly to the lungs via inhalation, they generally work very fast. This is why they are called rescue inhalers.

When are albuterol and levalbuterol inhalers used for asthma and COPD?

Both albuterol and levalbuterol inhalers are prescribed to people over the age of 4 with bronchospasms caused by asthma or COPD. Albuterol inhalers are specifically also approved for exercise-induced bronchospasms, or difficulty breathing during intense physical exercise. Taking albuterol 15 to 30 minutes before you exercise can help prevent breathing issues.

Both drugs are meant to be used as needed for severe asthma- or COPD-related breathing problems, but not every day as a long-term maintenance treatment. If you find yourself needing albuterol or levalbuterol more often than prescribed, talk to your provider to find a better option for managing your symptoms.

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How do I use albuterol and levalbuterol inhalers?

These inhalers are all used a bit differently depending on their design. Talk to your healthcare provider or pharmacist about how to use these inhalers. They can help you with tips for:

  • Setting up the device
  • Shaking it and preparing the medication for use
  • Storage
  • Cleaning
  • Proper inhalation technique


Albuterol and levalbuterol both require 2 inhalations by mouth every 4 to 6 hours. You should wait 60 seconds between each inhalation for better absorption.

Some people may only need 1 inhalation for either inhaler. Your provider will help you determine your number of doses. Using either albuterol or levalbuterol more frequently than recommended generally leads to more side effects.

What are the most common side effects of albuterol and levalbuterol inhalers?

People who use these inhalers typically have no side effect issues, but a few potential ones are worth mentioning. Keep in mind that this is not an all-inclusive list of side effects that can happen with these medications.

  • Throat irritation. Because these medications are inhaled, they may cause throat irritation as they pass into the lungs. A drink of water after the inhalation will help relieve the irritation.
  • Rapid heart rate. These medications may increase heart rate in some people. The receptors that these medications trigger are also found in the heart and can speed it up causing palpitations. This may be more noticeable with albuterol, or if you use either medication more than every 4 to 6 hours.
  • Headache and dizziness. Both medications can cause blood vessel constriction, possibly leading to headache or dizziness.
  • Hyperactivity or tremor. Because the medications can cause blood vessel constriction, they may make you feel more hyperactive or cause shaky hands. Again, this generally occurs when too much of the medication is taken.

Researchers don’t know for sure whether levalbuterol or albuterol causes more side effects. Clinicians are still debating this topic, and research is inconclusive. However, levalbuterol is thought to be less bothersome because levalbuterol acts mainly on the lungs, while albuterol is more likely to affect other parts of the body.

Do albuterol and levalbuterol inhalers have any drug interactions?

These medications have a low risk of drug interactions because they are not absorbed throughout the entire body. One interaction worth mentioning is with beta blockers. Beta blockers are often prescribed to treat heart problems or high blood pressure, and albuterol and levalbuterol can potentially make them less effective.

Albuterol and levalbuterol should be used with caution if you are taking certain antidepressants, as they may lead to more heart problems. Talk to your provider and pharmacist about what other medications may interact with albuterol or levalbuterol to get further guidance.

Do albuterol and levalbuterol inhalers require any special monitoring?

Some medications require that you take special tests to let your doctor know if they need to adjust your dosing. That’s not the case with albuterol and levalbuterol inhalers. Usually, no special tests are needed with these inhalers on top of your routine checkups and testing related to asthma and COPD.

Who should not take albuterol and levalbuterol inhalers?

People under the age of 4 generally should not be using these inhalers. This is because such young children may not be able to follow the inhalation instructions to ensure proper medication delivery to the lungs. They should instead use a nebulizer.

Otherwise, unless a person has a history of an allergic reaction (like hives or swollen throat) to these medications, then they are relatively safe to take.

How much do albuterol and levalbuterol inhalers cost?

Brand-name rescue inhalers can be quite expensive, but fortunately, both albuterol and levalbuterol are available as generic medications. The retail price for a typical prescription of either hovers around $60. Albuterol and levalbuterol are covered by most insurance plans, but always remember to shop around. If you don’t use insurance, patient assistance programs, pharmacy memberships, and coupons can help you save. To find the lowest price of these medications in your area, search for the drug on or the GoodRx mobile app, select your dose and quantity, and set your location.

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The bottom line

Overall, both albuterol and levalbuterol are useful medications if you have a history of asthma or COPD and have trouble breathing. They belong to the same class of medications, so they work similarly. Some providers believe that levalbuterol has fewer side effects, so it could be a good option if you have any issues with albuterol. Otherwise, which is best for you may likely come down to cost.

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  • A new type of inhaler is now available to deliver albuterol for patients with asthma or reversible COPD. The inhaler is called ProairRespiclick and is available for patients 12 years or older to treat acute symptoms of airway constriction (bronchospasm) or as prevention of exercise induced asthma symptoms. Most patients refer to albuterol inhaler as the “rescue” or “emergency” inhaler.
    Current albuterol inhalers (Ventolin, Proventil, Proair HFA) are all aerosol propelled meter dosed inhalers that most patients need a spacer or holding chamber to deliver medicine effectively. Respiclick inhaler is a dry powder inhaler and requires no spacer. The medicine is released and delivered into your lungs by your own breath effort (breath-actuated). This eliminates the need to coordinate dispensing the medicine with breathing in the medicine. This step frequently results in poor delivery of the medicine from traditional inhaler into your lungs.
    There are 200 doses per inhaler with dose counter to track doses remaining. No priming is required that would result in lost doses. Respiclick must stay dry at all times. Patients with severe cow’s milk allergy may not be candidate for this inhaler. Consult your Allergist to see if dry powder albuterol inhaler is right for you. Dosing directions and training on how to use this new style inhaler will be necessary to discuss with your doctor. Opening the mouth piece guard will generate a “click” and load the albuterol to inhale from the Respiclick. Educating patients with asthma on how and when to use their inhalers is a critical feature to a successful asthma management plan developed by Allergy Partners physicians, nurses, and asthma educators.


    What is albuterol?

    Albuterol is an inhaled medicine used to relieve symptoms of chronic obstructive pulmonary disease (COPD), such as breathlessness and wheezing. Albuterol is a type of short-acting beta-agonist bronchodilator, which is called SABA for short. Albuterol is the most common type of SABA used to treat COPD in the United States. Patients with COPD are usually prescribed albuterol as a key part of their COPD treatment plans.

    How does albuterol work?

    Albuterol can provide quick relief for bronchospasms caused by COPD. People with COPD have airways that are irritated and inflamed, which can cause the muscles that surround the airways to tighten up all of a sudden. This is called a bronchospasm, and it can make it hard to breathe because the airways become too narrow.

    To relieve a bronchospasm, albuterol quickly affects the cells in the lungs in a way that relaxes the muscles around the airways and opens up the breathing passages. Albuterol starts to take effect quickly, within minutes. Its effect usually lasts for between 4 and 8 hours.

    Bronchospasms and sudden worsening of COPD breathing symptoms can be part of an acute exacerbation, or COPD flare-up. For this reason, it is important to treat the symptoms quickly to keep the flare-up from getting worse and causing more damage. SABAs such as albuterol are the most effective and fast treatment for this.

    Patients usually take albuterol using a metered-dose inhaler. However, it can also be delivered using a nebulizer in some cases.

    How do people with COPD use albuterol to manage symptoms?

    People with earlier stages of COPD may have bronchospasms occasionally, and use their albuterol inhaler to relieve them as needed. Albuterol is sometimes called a “rescue” inhaler because it eases shortness of breath and can prevent a flare-up from getting worse.

    People with later stages of COPD may have trouble breathing all of the time or most of the time. They will usually be prescribed a maintenance treatment that is taken regularly every day to help reduce or prevent symptoms in the long term. However, most people will still have an albuterol inhaler to relieve sudden or severe symptoms quickly.

    Some COPD patients may still have shortness of breath that does not go away, even with maintenance treatment. They may be advised by healthcare providers to use albuterol regularly several times a day to help ease the breathlessness. If inhaled albuterol no longer works to relieve symptoms, then using a nebulizer can deliver albuterol in a more effective way.

    What are the brand names for albuterol?

    Albuterol is sold under several different brand names in the US:

    • ProAir HFA®
    • ProAir RespiClick®
    • Proventil HFA®
    • Proventil®
    • ReliOn Ventolin HFA®
    • Ventolin®
    • Ventolin HFA®
    • AccuNeb® – for use in nebulizers

    On January 15, 2019, GSK announced a generic version of Ventolin HFA®. Talk to your doctor if you are taking this medication and interested in learning more about the generic.

    What are the potential side effects of albuterol?

    Taking albuterol can cause side effects for some people. The most common ones are:

    • Shakiness
    • Fast or irregular heart beat
    • Heart pounding (palpitations)
    • Chest pain
    • Tremors
    • Nervousness

    If any of these side effects are severe or won’t go away, it’s important to contact your healthcare provider immediately.

    Albuterol can also cause some more serious side effects for a small number of people. You should stop taking albuterol and seek medical help right away if you have difficulty breathing after using the medicine, or if you have any signs of allergic reaction such as:

    • Hives
    • Rash
    • Itching
    • Swelling in the face, mouth, or body
    • Difficulty swallowing

    It is important to note that this is not exhaustive list of side effects. Talk to your doctor if you experience any adverse events.

    Breath of Fresh Air: Feature Articles

    Chapter 33: How many times a day can I safely use my bronchodilator inhaler?

    Bronchodilators are medications that relieve asthma symptoms by causing the muscles that surround the airways to relax, thereby opening the breathing passageways. Commonly used bronchodilator inhalers are albuterol (Ventolin® and Proventil®), metaproterenol (Alupent® and Metaprel®), and pirbuterol (Maxair® and Maxair Autohaler®).

    The medications in all of these bronchodilator inhalers are said to work for about 4-6 hours after you use them. Therefore, the simple answer to the question above is that it is safe to use these inhalers 4-6 times per day.

    (Note that the bronchodilator inhaler salmeterol (Serevent®) is the exception. Its effect lasts for approximately 12 hours and, therefore, should not be used more than twice per day. The remarks that follow do NOT pertain to salmeterol. Salmeterol should never be used for quick relief of symptoms of asthma.)

    The situation changes when asthma flares up and you are having an attack. If you have ever been to the Emergency Department of a hospital for your asthma, you know that bronchodilator medications can be given safely as often as every 20 minutes for quick relief of an asthma attack. The same is true at home. If you are having worsened asthma symptoms and need quick relief, you can safely use your inhaler as often as every 30-60 minutes for 2-3 hours without significant risk of harmful side effects. In particular, unless you have a known serious heart condition, there is no danger to your heart when using bronchodilator inhalers with this frequency for a short period of time.

    There is a risk from using your bronchodilator inhalers too much, but the danger is not to your heart. The risk is that over-reliance on a medication that only relaxes the muscles surrounding the breathing tubes will lead to a delay in the administration of other, needed medications that will reduce the swelling and congestion of the breathing tubes. That is to say, while you get brief relief of asthmatic symptoms from your bronchodilator inhaler, your asthma may be worsening as the breathing tubes become more swollen and filled with mucus. It is possible to overuse bronchodilators to the point of delaying other, crucial treatments, usually in the form of steroid medications taken in tablet form.

    Think of it this way: how often you need your bronchodilator medication for relief of asthmatic symptoms can be a useful indicator of how well your asthma is under control. If you need your bronchodilator inhaler every day, several times a day, there are probably better treatments that you should be receiving to keep your asthma quiet. If you need your bronchodilator inhaler as often as every 1-2 hours for relief of asthma symptoms, you are having an attack and need to do something immediately to prevent difficulty in breathing that is potentially dangerous. What actions to take in such an urgent situation should be specified as part of your asthma “Action Plan.” More about asthma “Action Plans” in Chapter 7, “Developing Your Asthma “Action Plan.”

    Albuterol for Asthma Control

    When you need a rescue inhaler to ease your asthma symptoms, chances are you’re not thinking about the medication that is relaxing your straining airways. You just know it works. But that medication is called albuterol, which is sold under various brand names including Proventil, Ventolin, AccuNeb, Vospire, and ProAir.

    Are you doing everything you can to manage your asthma? Find out with our interactive checkup.

    “Albuterol is the basic, quick-acting bronchodilator that is in common use today,” says Richard Castriotta, MD, professor of medicine and associate director of the Division of Pulmonary, Critical Care and Sleep Medicine at the University of Texas Medical School at Houston. “If there is any one drug that most asthmatics should have on board, it would probably be the albuterol inhaler.” There are some precautions that need to be taken, however. “The side effects from this drug are that if you use it too much, it can make the heart rate go up,” Dr. Castriotta says. Albuterol “has a duration of action of somewhere around four hours — six at the most — but it starts acting within 10 minutes.”

    Castriotta explains that albuterol alone can work for people whose asthma only occasionally flares up when they encounter trigger allergens or exercise. For this reason, in addition to the occasional symptom flare-up, albuterol is recommended for use before exercise to prevent exercise-induced asthma — just make sure you check out this use with your doctor first.

    Albuterol Inhaler: Limited Use, Best Use

    According to the National Heart, Lung, and Blood Institute, albuterol is not recommended for repeat use. If you use your albuterol inhaler two or more days a week to relieve asthma symptoms or if you have to use it repeatedly to control symptoms, your asthma is not well-controlled. You should talk with your doctor about changing your long-term asthma treatment medication.

    Caring for Your Albuterol Inhaler

    These instructions will help you keep your albuterol inhaler in good working order:

    • Prime your albuterol inhaler if you have not used it before or haven’t used it in two weeks or more. Priming your inhaler means prepping the device to deliver the medicine. Follow the instructions on your medicine’s packaging.
    • Breathe out fully before using your albuterol inhaler. Place the mouthpiece in your mouth and inhale slowly as you press down. Hold your breath for about 10 seconds and then breathe out. Wait one minute before taking another “puff” if your doctor recommends more than one.
    • Clean your mouthpiece in warm water at least once a week.
    • Store the inhaler at room temperature away from extreme heat. Do not store it in your car!

    Side Effects and Warnings for Albuterol

    Albuterol is intended only for the relief of occasional symptoms; an overdose can be fatal. If you used albuterol as your doctor told you but have not found relief, contact your doctor.

    You should not use albuterol if you have ever experienced an allergic “hypersensitivity” reaction to it. Caution should be taken with use of albuterol if you have any of the following:

    • An abnormal heart rhythm
    • Diabetes
    • Epilepsy or other seizure disorder
    • Heart disease or congestive heart failure
    • Overactive thyroid

    If any of these conditions applies to you, have a discussion with your doctor about how to best and most safely use your albuterol medication. And in all cases, call your doctor if you have any of the following side effects:

    • wheezing
    • Tight chest
    • Chest pain
    • Pounding heart
    • Tremor
    • Nervousness
    • Very high blood pressure characterized by confusion, headache, blurred vision

    The New Generation of Albuterol Inhalers

    Recent changes to the design of inhalers have made them more environmentally friendly, but you might have to take some time to adjust to them. For years, rescue inhalers have been a source of chlorofluorocarbons, which damage the atmosphere. But starting Jan. 1, 2009, manufacturers can use only hydrofluoroalkane as a propellant. It has less of an impact on the ozone layer.

    This change means you’ll need to take a little more time to prime your inhaler, inhale with more force so the albuterol reaches your lungs, and clean your mouthpiece with extra care. If you have concerns, bring them to your doctor. Using the inhaler right makes all the difference.

    Albuterol Side Effects

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    “It’s what you reach for when you really need something,” Horovitz told Live Science. “It’s an ‘I need it now’ drug.”

    Inhaler and tablet dosage

    Adults and kids over age 4 in need of albuterol to prevent or treat bronchospasms can take two puffs every four to six hours, Horovitz said. To prevent exercise-induced bronchospasm, the Mayo Clinic says adults and children over 4 can take two inhaler puffs about 15 to 30 minutes before exercise.

    But “if you’re using albuterol more than twice a week, there’s something wrong with your regimen, and you need to consult a doctor,” he said.

    Albuterol can be taken as a nebulized solution (a liquid that has been turned into an inhalable mist via a nebulizer machine) or as an aerosol that can be inhaled by mouth through an inhaler.

    Aerosol inhaler albuterol comes in canisters designed to provide about 200 inhalations. After using the exact number of inhalations, it is important to throw the canister away, even if it still contains some liquid and continues to spray. Once the listed number of puffs has been exceeded, the inhaler may not provide the correct amount of medicine. Some inhalers come with a counter that keeps track of the number of sprays used. When the number reaches 020, it is time to call the doctor for a refill. If there is no counter, patients must keep track of inhalations on their own.

    The National Institutes for Health (NIH) has step-by-step instructions for using an inhaler and a nebulizer.

    Patients taking albuterol through tablets, extended-release tablets or liquid should follow their doctor’s instructions exactly. It is important to swallow the extended-release tablet whole and not to chew, crush or break it. Part of the extended-release tablet may appear in patients’ stools while using the medicine. This is not a problem and no cause for concern.

    Side effects

    Albuterol may cause side effects. The NIH lists the following as less serious, though a doctor should be consulted if they don’t go away:

    • uncontrollable shaking of a part of the body
    • nervousness
    • headache
    • nausea
    • vomiting
    • cough
    • throat irritation
    • muscle, bone, or back pain

    The following are more serious side effects and, if experienced, a doctor should be consulted immediately:

    • fast, pounding, or irregular heartbeat
    • chest pain
    • rash
    • hives
    • itching
    • swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs
    • increased difficulty breathing
    • difficulty swallowing
    • hoarseness

    It is possible to overdose on albuterol. The following are symptoms of overdose:

    • seizures
    • chest pain
    • fast, irregular or pounding heartbeat
    • nervousness
    • headache
    • uncontrollable shaking of a part of the body
    • dry mouth
    • nausea
    • dizziness
    • excessive tiredness
    • lack of energy
    • difficulty falling asleep or staying asleep

    Before taking albuterol, patients should tell their doctor if they suffer from any of the following symptoms:

    • heart disease, congestive heart failure, heart rhythm disorder, or high blood pressure
    • epilepsy or another seizure disorder
    • diabetes
    • overactive thyroid

    Patients should tell their doctor if they are pregnant or are planning to become pregnant. However, “the most harmful thing to an embryo or fetus is lack of oxygen,” and women should take albuterol if they need it and if their doctor approves, Horovitz said. Between 4 percent and 12 percent of pregnant women in the U.S. have asthma; and 3 percent of pregnant women take asthma medications, including bronchodilators like albuterol, according to the CDC.

    A study published in the January 2012 issue of the journal Pediatrics showed that using asthma medicines during pregnancy — albuterol was the most common such medicine used in the study — didn’t increase the risk for most birth defects studied. However, it showed that the medication might increase the risk for some birth defects, such as birth defects of the esophagus, anus and abdominal wall.

    The FDA categorizes albuterol as a category C drug, meaning that it is unknown if it could harm a fetus. It’s also unknown about its effects during breastfeeding, so women should proceed with caution before taking it, according to the Mayo Clinic.

    Additional resources:

    • Go to the NIH to find out when it is best to use albuterol.
    • Find out how much an albuterol inhaler should cost at Cost Helper.
    • Information about albuterol from PubMed Health.

    This article is for informational purposes only and is not meant to offer medical advice. This article was updated on May 13, 2015 by Live Science Senior Writer, Laura Geggel, and again on Oct. 17, 2018 by Live Science Managing Editor, Jeanna Bryner.

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