From the Research
The recommended order for administering these respiratory medications is: Atrovent (ipratropium bromide) first, followed by 3% sodium chloride (hypertonic saline), then Brovana (arformoterol), and finally Budesonide. This sequence maximizes effectiveness by starting with the bronchodilator Atrovent to open airways, followed by the mucolytic sodium chloride to thin secretions. Once airways are open and mucus is thinned, Brovana (a long-acting beta-agonist) can work more effectively to maintain bronchodilation. Budesonide, an inhaled corticosteroid, should be administered last as it needs to coat the airways and remain there to reduce inflammation.
Key Considerations
- The order of administration is crucial to ensure optimal absorption and effectiveness of each medication.
- Allowing 1-2 minutes between medications can help prevent interference with absorption and maximize the therapeutic effect.
- Rinsing the mouth after using Budesonide can help prevent oral thrush, a common side effect of inhaled corticosteroids.
- The most recent and highest quality study 1 supports the use of inhaled budesonide and ipratropium bromide combination in patients at high risk of acute respiratory distress syndrome development, which informs the recommended order of administration.
Supporting Evidence
- A randomized controlled trial 1 demonstrated that the administration of inhaled budesonide and ipratropium bromide improved oxygenation and significantly reduced the rate of acute respiratory distress syndrome development and the requirement of mechanical ventilation.
- Other studies 2, 3, 4, 5 have shown the efficacy and safety of combination therapy with inhaled corticosteroids and beta agonists in patients with asthma and chronic obstructive pulmonary disease, supporting the recommended order of administration.