Formoterol (brand names Perforomist, Foradil) is a bronchodilator in a class of medications called long-acting beta agonists (LABAs). It is used to control wheezing, shortness of breath, coughing and chest tightness in people with COPD. Formoterol is not intended to treat asthma and can cause severe risks to asthma patients. It works for COPD patients by relaxing and opening the airways to the lungs, making it easier to breathe.

How does formoterol for COPD work?

Formoterol is a long-acting beta2-adrenergic receptor agonist (beta2-agonist) that works in the lungs as a bronchodilator. Its action has a rapid onset and its effects are maintained for at least 12 hours.

It becomes effective after binding to correspondent receptors, called beta-adrenoceptors, and activating them by stimulating the adenyl cyclase, an enzyme found inside the cells of the lung muscles and is involved in the synthesis of cyclic adenosine monophosphate (cAMP). When cAMP levels are elevated, the muscle cells of the airways become relaxed, leading to bronchodilation.

There are three types of beta-adrenoceptors in three different types of cells: the muscle cells of the airways, the heart, and the adipose (fat) tissue cells. This means that formoterol may have functions in other cells, but its precise function is not known.

Studies of formoterol

The effectiveness of formoterol in the treatment of COPD has been shown in various clinical studies, whether as a pressurized metered dose inhaler or a dry powder inhaler.

Most studies show that formoterol has proven efficacy, safety, and tolerability profiles in  people with COPD.

The National Heart, Lung and Blood Institute and the World Health Organization collaborated on the Global Initiative for COPD – GOLD, and according to this initiative, long-acting bronchodilators are of primary importance to manage COPD symptoms, are used on an as-need or regular basis to reduce or prevent symptoms, and are convenient and effective.

Most studies evaluating formoterol for the treatment of COPD attribute its success to its rapid action and selective activity toward the beta2-adrenergic receptors. Formoterol can work as rapidly as five minutes, and its effects are maintained for up to 12 hours.

Studies have also shown that formoterol controls symptoms better than ipratropium and is more effective than theophylline in reducing exacerbations and increasing the number of days without rescue medication, and with a better tolerance.

Indications and side effects

Formoterol is not intended to be used to treat asthma. People with asthma who take LABA medicines such as formoterol have an increased risk of death due to severe asthma problems.

Formoterol won’t cure COPD but it will help relieve symptoms of the condition. It also doesn’t relieve sudden breathing difficulties. For an attack that has already started, short-acting bronchodilators such as albuterol, levalbuterol, ipratroprium or the combination albuterol/ipratropium can be used if prescribed by your doctor.

Formoterol side effects can include flu-like symptoms, headache, sore throat, dry throat, cough, runny nose, chills, fever, loss of voice, muscle cramps, or swollen glands in the neck. See your doctor if these occur.

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