From the Guidelines
I strongly advise against using Air Supra (albuterol) and DuoNebs (albuterol and ipratropium bromide) together, as this would result in a double dose of albuterol, potentially increasing the risk of side effects such as rapid heart rate, tremors, and nervousness. According to the guidelines for managing asthma exacerbations 1, the recommended dose of albuterol for adults is 2.5–5 mg every 20 minutes for 3 doses, then 2.5–10 mg every 1–4 hours as needed. DuoNebs already contain albuterol combined with ipratropium bromide, so adding Air Supra would be redundant for the albuterol component.
If you're experiencing respiratory symptoms that aren't controlled by one medication alone, it's essential to speak with your healthcare provider about proper medication combinations. They might adjust your dosage, timing between medications, or recommend a different treatment approach altogether. Both medications work as bronchodilators to open airways, but using them together inappropriately could lead to overmedication.
The guidelines also suggest that ipratropium bromide can be added to SABA therapy for severe exacerbations, but it should not be used as first-line therapy 1. Additionally, the expert panel report 3 (EPR-3) guidelines for the diagnosis and management of asthma recommend that ipratropium bromide can be used in combination with albuterol for up to 3 hours in the initial management of severe exacerbations 1. However, the most recent and highest quality study should be prioritized, which in this case is the 2009 guidelines for managing asthma exacerbations 1.
Your healthcare provider can create a personalized treatment plan that safely addresses your respiratory needs, taking into account the potential risks and benefits of different medication combinations. It's crucial to follow their recommendations and not self-medicate with multiple bronchodilators without proper guidance.
From the FDA Drug Label
Ipratropium Bromide Inhalation Solution can be mixed in the nebulizer with albuterol or metaproterenol if used within one hour but not with other drugs. Drug stability and safety of Ipratropium Bromide Inhalation Solution when mixed with other drugs in the nebulizer have not been established.
The FDA drug label does not answer the question about using Air Supra and Duonebs together, as Air Supra and Duonebs are not mentioned in the provided drug labels.
From the Research
Air Supra and Duonebs Usage
- The provided studies do not directly address the use of Air Supra and Duonebs together.
- However, the studies discuss the combination of ipratropium bromide and albuterol, which are ingredients found in Duonebs, for the treatment of chronic obstructive pulmonary disease (COPD) and acute asthma 2, 3, 4, 5.
- According to the studies, the combination of ipratropium bromide and albuterol has been shown to be effective in improving lung function and reducing symptoms in patients with COPD and acute asthma 2, 3, 4, 5.
- One study compared the efficacy of continuous nebulized albuterol alone versus continuous nebulized albuterol plus ipratropium bromide for the treatment of acute asthma, and found no significant difference in mean improvement of peak expiratory flow rates (PEFR) at 60 or 120 minutes between the two groups 5.
- Another study found that a combined formulation of ipratropium and albuterol led to lower respiratory-related healthcare use and charges, and improved compliance compared to treatment with separate ipratropium and beta2-agonist inhalers 3.
- A study also demonstrated that ipratropium bromide/albuterol delivered via Respimat inhaler had comparable efficacy to ipratropium bromide/albuterol MDI for forced expiratory volume in 1 second (FEV1) area under the curve at 0-6 hours (AUC(0-6)) 4.
Combination Therapy
- The combination of ipratropium bromide and albuterol has been shown to be effective in improving lung function and reducing symptoms in patients with COPD and acute asthma 2, 3, 4, 5.
- The use of a single inhaler containing both ipratropium and albuterol can increase compliance and decrease respiratory morbidity and charges compared to separate inhalers for these two agents 3.
Safety and Efficacy
- The studies found that the combination of ipratropium bromide and albuterol was well tolerated and had comparable safety to ipratropium bromide/albuterol MDI 4.
- One study found that there were no significant differences in mean improvement of PEFR at 60 or 120 minutes between patients receiving continuous albuterol alone versus those receiving albuterol in combination with ipratropium bromide 5.