Examples
Combination of an anticholinergic (ipratropium) and a
short-acting beta2-agonist (albuterol):
| ipratropium and albuterol |
Combivent, DuoNeb |
Ipratropium alone and combined with albuterol is available
in metered-dose
inhalers (MDI) and as a liquid form for use in
compressor-driven
nebulizers. Inhalers may be used differently,
depending on the medicine used. Always read the directions to be sure you are
using the inhaler correctly.
How It Works
Anticholinergics relax the airways and
prevent them from getting narrower. This makes it easier to breathe. They may
protect the airways from spasms that can suddenly cause the airway to become
narrower (bronchospasm). They also may reduce the amount of
mucus produced by the airways.
Anticholinergics begin to work within 15 minutes, work best after 1 to 2
hours, and usually last from 3 to 4 hours (but may last up to 6 hours in some
people).
Why It Is Used
Inhaled anticholinergics are usually
used for severe
asthma attacks. They are sometimes used in the home,
but they are not used as daily maintenance treatment for persistent
asthma. And they are always used with another
medicine.
Anticholinergics may be used:
- Along with short-acting beta2-agonists to treat
severe asthma attacks or
status asthmaticus, a long-lasting and severe asthma
attack that does not respond to standard treatment.
- As an added
medicine used after short-acting beta2-agonists during an asthma attack. The
combination may relieve symptoms for a longer period of time.
Medicine treatment for asthma depends on a person’s age,
his or her type of asthma, and how well the treatment is controlling asthma
symptoms.
- Children up to age 4 usually are treated a
little differently from those 5 to 11 years old.
- The least amount
of medicine that controls the asthma symptoms is used.
- The amount
of medicine and number of medicines are increased in steps. So if asthma is not
controlled at a low dose of one controller medicine, the dose may be increased.
Or another medicine may be added.
- If the asthma has been under
control for several months at a certain dose of medicine, the dose may be
reduced. This can help find the least amount of medicine that will control the
asthma.
- Quick-relief medicine is used to treat asthma attacks. But
if you or your child needs to use quick-relief medicine a lot, the amount and
number of controller medicines may be changed.
Your doctor will work with you to help find the number and
doses of medicines that work best.
How Well It Works
A review of research shows that
combining ipratropium with a short-acting beta2-agonist:1, 2
- Improves lung function compared to using a
short-acting beta2-agonist alone.
- Reduces hospital admission in
adults and children with severe asthma attacks.
Side Effects
Side effects are rare with inhaled
ipratropium but may include:
- Dry mouth.
- Increased
wheezing.
- Delay in bringing relief from
symptoms (if used without short-acting beta2-agonists).
See Drug Reference for a full list of side effects. (Drug
Reference is not available in all systems.)
What To Think About
Anticholinergics are not used
alone to treat asthma. They are always given along with short-acting inhaled
beta2-agonists to treat severe asthma attacks, especially in children.
Many doctors recommend that every child who uses a metered-dose inhaler
(MDI) also use a
spacer, which is attached to the MDI. A spacer may
deliver the medicine to the lungs better than an inhaler alone. And for many
people a spacer is easier to use than an MDI alone.
Try to avoid
giving your child an inhaled medicine when he or she is crying, because not as
much medicine is delivered to the lungs.
If you have the eye
disease glaucoma, talk with an eye doctor before you start taking
anticholinergics. People who have glaucoma may need to be watched more closely
while they are taking these medicines.
Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.
References
Citations
-
Dennis RJ, et al. (2007). Asthma in adults, search
date October 2006. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
-
Keeley D, McKean M (2006). Asthma and other wheezing
disorders in children, search date October 2005. Online version of
BMJ Clinical Evidence:
http://www.clinicalevidence.com.
Credits
|
By
|
Healthwise Staff |
|
Primary Medical Reviewer
|
Michael J. Sexton, MD - Pediatrics |
|
Specialist Medical Reviewer
|
Harold S. Nelson, MD - Allergy and Immunology |
|
Last Revised
|
March 20, 2009 |
Dennis RJ, et al. (2007). Asthma in adults, search
date October 2006. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
Keeley D, McKean M (2006). Asthma and other wheezing
disorders in children, search date October 2005. Online version of
BMJ Clinical Evidence:
http://www.clinicalevidence.com.