Albuterol (ProAirVentolin/Proventil) is most often used as a short-acting, inhaled therapy for bronchospasm. It works via β-2 agonism – adrenergic receptors that relax bronchial smooth muscle through cyclic AMP-mediated signaling. Levoalbuterol (Xopenex) is the active enantiomer of albuterol and confers better β-2 selectivity to avoid β-1 effects like tachycardia.
As an anesthesiologist, I most often use albuterol to optimize patients with active wheezing pre-operatively or to treat bronchospasm related to airway manipulation, secretions, etc. in the perioperative period.
As an intensivist, albuterol helps me treat patients with the aforementioned conditions as well as severe asthma exacerbations (ie, status asthmaticus) and hyperkalemia. Remember, albuterol does NOT ELIMINATE potassium, but simply causes it to shift intracellularly (similar to insulin/glucose). Electrolyte checks are therefore imperative in patients receiving continuous albuterol therapy.
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