From the Guidelines
When using both Atrovent (ipratropium bromide) and Breo (fluticasone furoate/vilanterol), you should administer Atrovent first, followed by Breo, as Atrovent is a helpful adjunctive therapy in the emergency care setting, according to the expert panel report 3 (epr-3) guidelines 1. This recommendation is based on the fact that inhaled ipratropium bromide is a helpful adjunctive therapy in the emergency care setting, as stated in the guidelines 1. Some key points to consider when administering these medications include:
- Waiting approximately 5-10 minutes between the two medications for optimal effectiveness
- Using Atrovent first to open the airways, which then allows the Breo medication to penetrate deeper into the lungs and work more effectively
- Rinsing your mouth after using Breo to prevent potential side effects like oral thrush
- Following the general rule of using rescue inhalers first, followed by bronchodilators, and then inhaled steroids or combination products last It's also important to note that the guidelines recommend considering adjunctive treatments, such as intravenous magnesium sulfate or heliox, in severe exacerbations, if patients are unresponsive to the initial treatments listed 1. Additionally, providing a referral to follow-up asthma care within 1 to 4 weeks, reviewing the patient’s written asthma action plan, and considering a step up in therapy are crucial for preventing relapse of the exacerbation and recurrence of another exacerbation 1.
From the Research
Administration of Atrovent or Breo
- The provided studies do not directly compare the administration of Atrovent (ipratropium bromide) and Breo (fluticasone furoate/vilanterol) in terms of which one should be administered first 2, 3, 4, 5, 6.
- Atrovent is an anticholinergic drug that can be used to treat obstructive lung disease, and its administration via inhalation is considered the most suitable route 2.
- Breo, on the other hand, is a combination of an inhaled corticosteroid and a long-acting β2-agonist, used to treat COPD and asthma 5, 6.
- Studies have shown that Atrovent can be effective in improving lung function and reducing hospitalization rates when used in conjunction with beta2-agonists for the treatment of acute asthma exacerbation 4.
- Breo has been shown to be effective in improving lung function and reducing exacerbation rates in patients with mild-to-moderate asthma, and its once-daily administration has been associated with higher adherence to treatment 5.
- A study comparing Breo with tiotropium, another anticholinergic drug, found that both treatments were efficacious in improving lung function in patients with COPD and comorbid cardiovascular disease or risk factors, with minor differences in efficacy and safety profiles 6.
Considerations for Administration
- The decision to administer Atrovent or Breo first may depend on the specific clinical context and the patient's individual needs and medical history.
- It is essential to consider the potential benefits and risks of each treatment, as well as any potential interactions between the two medications.
- Further research is needed to determine the optimal order of administration for these two medications.