Long-acting beta-2 agonists (eg, salmeterol, formoterol) are typically used for maintenance therapy in COPD or with inhaled corticosteroids in asthma. These drugs have a lipophilic side chain, which allows them to attach to the plasma membrane and diffuse laterally across to the beta-2 receptor. As a result, they have an extended duration of action (≥12 hours) but slow onset of action.Salmeterol has a slightly longer duration of action than formoterol due to its ability to bind a secondary exosite within the beta-2 receptor, which serves as an anchor to prevent active site dissociation.
Short-acting beta-2 agonists (eg, albuterol, levalbuterol) are typically used for acute symptom relief. These drugs are relatively hydrophilic, interact minimally with the plasma membrane, and are rapidly metabolized, explaining their rapid onset (minutes) and short duration of action (4-6 hours)
Adverse effects
Cardiac: ventricular arrhythmias, tachycardia
Central nervous system/muscular: tremor
Electrolytes
Hyperglycemia
β2-mediated stimulation in the liver → elevated cAMP levels → increased glycogenolysis
Hypokalemia (risk of life-threatening arrhythmias): β2-mediated stimulation of Na+/K+-ATPase → intracellular K+ shift