From the Guidelines
Ipratropium bromide is recommended for cough suppression in patients with cough due to upper respiratory infection (URI) or chronic bronchitis, as it has shown substantial benefit in these cases. Ipratropium works as an anticholinergic bronchodilator that blocks muscarinic receptors in the airways, reducing mucus secretion and bronchial constriction. For patients with COPD who experience chronic cough, ipratropium may be used as an inhaled medication, typically 2 puffs (34 mcg per puff) four times daily, as recommended by the ACCP evidence-based clinical practice guidelines 1. The medication begins working within 15-30 minutes and lasts for 4-6 hours. Side effects can include dry mouth, throat irritation, and rarely, urinary retention or worsening of glaucoma.
Key Points to Consider
- Ipratropium bromide is specifically recommended for patients with chronic bronchitis or those with cough due to URI, with a grade of recommendation A and fair level of evidence 1.
- For most types of acute cough, especially those caused by upper respiratory infections, ipratropium has not shown significant benefit, and other treatments such as dextromethorphan for dry coughs or guaifenesin for productive coughs are generally more appropriate first choices.
- Patients should consult with their healthcare provider before using ipratropium for cough, as the underlying cause of the cough should determine the appropriate treatment approach, considering the latest guidelines and evidence 1.
Treatment Approach
- In stable patients with chronic bronchitis, therapy with ipratropium bromide should be offered to improve cough, with a level of evidence of fair and a grade of recommendation A 1.
- For patients with an acute exacerbation of chronic bronchitis, therapy with short-acting β-agonists or anticholinergic bronchodilators should be administered during the acute exacerbation, with a level of evidence of good and a grade of recommendation A 1.
- In patients with postinfectious cough, consider a trial of inhaled ipratropium as it may attenuate the cough, with a level of evidence of fair and a grade of evidence B 1.
From the FDA Drug Label
PRECAUTIONS General Ipratropium bromide should be used with caution in patients with narrow-angle glaucoma, prostatic hypertrophy or bladder-neck obstruction. Information for Patients Patients should be advised that temporary blurring of vision, precipitation or worsening of narrow-angle glaucoma or eye pain may result if the solution comes into direct contact with the eyes Use of a nebulizer with mouthpiece rather than face mask may be preferable, to reduce the likelihood of the nebulizer solution reaching the eyes. Patients should be advised that ipratropium bromide inhalation solution can be mixed in the nebulizer with albuterol or metaproterenol if used within one hour Drug stability and safety of Ipratropium Bromide Inhalation Solution when mixed with other drugs in a nebulizer have not been established. Patients should be reminded that ipratropium bromide inhalation solution should be used consistently as prescribed throughout the course of therapy
The ipratropium bromide is used for treating bronchospasm, however, there is no information that directly supports its effectiveness for treating coughing.
- The drug label does not mention coughing as an indication for ipratropium bromide.
- Ipratropium bromide should be used as prescribed throughout the course of therapy 2. The FDA drug label does not answer the question.
From the Research
Effectiveness of Ipratropium for Coughing
- Ipratropium bromide is an anticholinergic drug that has been used to treat chronic obstructive pulmonary disease (COPD) and other respiratory conditions 3, 4.
- Studies have shown that ipratropium can provide bronchodilation and improve lung function in patients with COPD and asthma 4, 5.
- In terms of coughing, ipratropium has been used as an adjunctive therapy for the treatment of acute asthma exacerbation, and has been shown to improve lung function and reduce hospitalization rates when used in combination with beta2-agonists 5.
- However, the effectiveness of ipratropium for coughing in patients with COPD is less clear, and some studies have suggested that long-acting antimuscarinics such as tiotropium may be more effective in improving health outcomes 3, 6.
Comparison with Other Treatments
- Ipratropium has been compared to other treatments such as beta2-agonists and anticholinergic agents, and has been shown to have similar efficacy in some studies 4, 7.
- However, other studies have suggested that long-acting beta2-agonists such as salmeterol and formoterol may be more effective in improving lung function and reducing symptoms in patients with COPD 6, 7.
- The choice of treatment for coughing will depend on the individual patient's condition and response to treatment, as well as the presence of any underlying respiratory conditions 6.