Breathing Treatment Options for Patients with Tachycardia and Atrovent Allergy
For patients with tachycardia who are allergic to ipratropium bromide (Atrovent), short-acting beta-agonists (SABAs) like albuterol or levalbuterol are the recommended first-line breathing treatment options. 1
First-Line Treatment Options
Albuterol (salbutamol) is the primary recommended treatment for patients with respiratory distress who cannot use ipratropium. It can be delivered via metered-dose inhaler (MDI) with spacer or nebulizer, with both delivery methods showing comparable efficacy 1
Levalbuterol (Xopenex), the R-isomer of albuterol, is an alternative to racemic albuterol with potentially fewer cardiac side effects in some patients, though clinical studies show mixed results regarding its advantage over albuterol 1, 2
Short-acting beta-agonists are the treatment of choice for relief of acute respiratory symptoms and prevention of exercise-induced bronchoconstriction 1
Considerations for Patients with Tachycardia
In critically ill patients, studies have shown that nebulized albuterol does not cause significant increases in heart rate or tachyarrhythmias, making it generally safe even in patients with baseline tachycardia 3, 4
For patients with tachycardia, levalbuterol at 0.63 mg dose showed no significant difference in heart rate changes compared to albuterol 2.5 mg (mean change 0.85 vs 0.89 beats/min) 3
In patients without baseline tachycardia, both albuterol and levalbuterol caused small but statistically significant increases in heart rate (4.4 beats/min and 3.6 beats/min respectively) 4
Alternative and Adjunctive Treatments
Magnesium sulfate can be considered as an adjunct therapy for patients with severe respiratory distress. When combined with nebulized beta-adrenergic agents, IV magnesium sulfate can moderately improve pulmonary function with only minor side effects 1
For patients with severe refractory bronchospasm, providers may consider IV magnesium at the standard adult dose of 2 g administered over 20 minutes 1
Systemic corticosteroids should be considered for patients with asthma exacerbations, as they are the only treatment proven effective for the inflammatory component. Early administration hastens the resolution of airflow obstruction 1
Special Considerations and Precautions
Be aware of the potential for paradoxical bronchospasm with beta-agonist inhalers, which can occur in some patients. If this occurs, discontinue the beta-agonist and consider alternative treatments 5
For patients on beta-blockers who experience severe bronchospasm, consider glucagon (1-5 mg IV over 5 minutes followed by infusion) as it can help relax bronchial smooth muscle independent of beta-blockade 1
In patients with severe cardiac disease where beta-agonists pose significant risk, consider epinephrine or terbutaline administered subcutaneously as alternative bronchodilators 1
Monitoring and Follow-up
Monitor heart rate, blood pressure, and oxygen saturation before and after administration of beta-agonists in patients with tachycardia 3
For patients with persistent tachycardia despite treatment, consider continuous cardiac monitoring, especially if multiple doses of beta-agonists are required 1
If the patient develops worsening tachycardia or other cardiac symptoms during treatment, consider reducing the dose or frequency of beta-agonist administration 1