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Combination of an anticholinergic (ipratropium) and a
short-acting beta2-agonist (albuterol):
Ipratropium alone and combined with albuterol is available
inhalers (MDI) and as a liquid form for use in
nebulizers. Inhalers may be used differently,
depending on the medicine used. Always read the directions to be sure you are
using the inhaler correctly.
Anticholinergics relax the airways and
prevent them from getting narrower. This makes it easier to breathe. They may
protect the airways from spasms that can suddenly cause the airway to become
narrower (bronchospasm). They also may reduce the amount of
mucus produced by the airways.
Anticholinergics begin to work within 15 minutes, work best after 1 to 2
hours, and usually last from 3 to 4 hours (but may last up to 6 hours in some
Inhaled anticholinergics are usually
used for severe
asthma attacks. They are sometimes used in the home,
but they are not used as daily maintenance treatment for persistent
asthma. And they are always used with another
Anticholinergics may be used:
Medicine treatment for asthma depends on a person's age,
his or her type of asthma, and how well the treatment is controlling asthma
Your doctor will work with you to help find the number and
doses of medicines that work best.
A review of research shows that
combining ipratropium with a short-acting beta2-agonist:1, 2
All medicines have side effects. But many people don't feel the side effects, or they are able to deal with them. Ask your pharmacist about the side effects of each medicine you take. Side effects are also listed in the information that comes with your medicine.
Here are some important things to think about:
Side effects are rare with inhaled
ipratropium but may include:
See Drug Reference for a full list of side effects. (Drug
Reference is not available in all systems.)
Anticholinergics are not used
alone to treat asthma. They are always given along with short-acting inhaled
beta2-agonists to treat severe asthma attacks, especially in children.
Many doctors recommend that every child who uses a metered-dose inhaler
(MDI) also use a
spacer, which is attached to the MDI. A spacer may
deliver the medicine to the lungs better than an inhaler alone. And for many
people a spacer is easier to use than an MDI alone.
Try to avoid
giving your child an inhaled medicine when he or she is crying, because not as
much medicine is delivered to the lungs.
If you have the eye
disease glaucoma, talk with an eye doctor before you start taking
anticholinergics. People who have glaucoma may need to be watched more closely
while they are taking these medicines.
Medicine is one of the many tools your doctor has to treat a health problem. Taking medicine as your doctor suggests will improve your health and may prevent future problems. If you don't take your medicines properly, you may be putting your health (and perhaps your life) at risk.
There are many reasons why people have trouble taking their medicine. But in most cases, there is something you can do. For suggestions on how to work around common problems, see the topic Taking Medicines as Prescribed.
If you are pregnant, breast-feeding, or planning to get pregnant, do not use any medicines unless your doctor tells you to. Some medicines can harm your baby. This includes prescription and over-the-counter medicines, vitamins, herbs, and supplements. And make sure that all your doctors know that you are pregnant, breast-feeding, or planning to get pregnant.
Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.
Complete the new medication information form (PDF)new medication information form (PDF)(What is a PDF document?) to help you understand this medication.
Rodrigo G (2011). Asthma in adults (acute), search date April 2010. BMJ Clinical Evidence. Available online: http://www.clinicalevidence.com.
Okpapi A, et al. (2012). Asthma and other recurrent wheezing disorders in children (acute), search date June 2010. BMJ Clinical Evidence. Available online: http://www.clinicalevidence.com.
March 14, 2013
John Pope, MD - Pediatrics & Lora J. Stewart, MD - Allergy and Immunology
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