From the Guidelines
Ipratropium bromide is recommended for use in acute asthma exacerbations in the emergency department, particularly when combined with short-acting beta-agonists like albuterol, as it has been shown to increase bronchodilation and reduce hospitalizations 1.
Key Points
- Ipratropium bromide is an anticholinergic bronchodilator medication used to treat chronic obstructive pulmonary disease (COPD) and sometimes asthma.
- The typical dose for adults is 2 inhalations (36 mcg) four times daily using a metered-dose inhaler, or 500 mcg via nebulizer 3-4 times daily.
- For acute exacerbations, it can be combined with short-acting beta-agonists like albuterol for enhanced bronchodilation.
- Ipratropium has a slower onset (15-30 minutes) but longer duration (4-6 hours) compared to beta-agonists.
- Common side effects include dry mouth, throat irritation, and headache.
- Unlike systemic anticholinergics, ipratropium has minimal systemic absorption when inhaled, reducing the risk of systemic side effects.
Clinical Use
- Ipratropium bromide is particularly effective for COPD patients with the chronic bronchitis phenotype and can be used safely in patients with cardiovascular conditions where beta-agonists might pose risks.
- Patients should rinse their mouth after use to prevent dry mouth and potential oral fungal infections.
- In the emergency department, multiple high doses (0.5 mg of nebulizer solution or 8 puffs by means of MDI in adults and 0.25-0.5 mg of nebulizer solution or 4-8 puffs by means of MDI in children) should be added to beta-agonist therapy to increase bronchodilation 1.
Important Considerations
- The combination of a beta-agonist and inhaled ipratropium bromide has been shown to reduce hospitalizations, particularly in patients with severe airflow obstruction 1.
- Nebulised bronchodilators should be continued for 24-48 hours or until the patient is improving clinically, and then can be switched to metered dose aerosol or dry powder inhalers 1.
From the FDA Drug Label
INDICATIONS AND USAGE Ipratropium bromide inhalation solution administered either alone or with other bronchodilators, especially beta adrenergics, is indicated as a bronchodilator for maintenance treatment of bronchospasm associated with chronic obstructive pulmonary disease, including chronic bronchitis and emphysema. The use of Ipratropium bromide is as a bronchodilator for the maintenance treatment of bronchospasm associated with:
- Chronic obstructive pulmonary disease (COPD)
- Chronic bronchitis
- Emphysema 2
From the Research
Uses of Ipratropium Bromide
Ipratropium bromide is an inhalation bronchodilator used in the treatment of various respiratory conditions, including:
- Chronic obstructive pulmonary disease (COPD) 3, 4, 5
- Asthma 3, 4, 6
- Chronic bronchitis 3, 4, 5
- Emphysema 3, 5
Mechanism of Action
Ipratropium bromide works by interrupting vagally mediated bronchoconstriction, inhibiting the cyclic guanosine 3',5'-monophosphate system at parasympathetic nerve endings 3. It is a quaternary anticholinergic bronchodilator that produces bronchodilation in most patients with obstructive airways disease 4.
Efficacy and Safety
Studies have shown that ipratropium bromide is effective in producing bronchodilation in patients with COPD and asthma 3, 4, 5, 6. It has been found to be safe and tolerated in most patients, with mild adverse effects such as cough, nausea, and dry mouth 3, 4. The addition of ipratropium to beta2-agonist therapy has been shown to improve lung function and decrease hospitalization rates in patients with acute asthma exacerbation 6.
Dosage and Administration
The usual dosage of ipratropium bromide is two inhalations (36 micrograms) four times daily, with a maximum of 12 doses per day 3. It can be administered via metered-dose inhaler or nebulized solution, with the optimal dose being 0.4 mg for nebulized solution 7.