Ipratropium Bromide

Ipratropium bromide (pronounced as “i-pra-TROE-pee-um”) is an inhalation solution that belongs to the drug class of bronchodilators. Atrovent is one of the brand names of ipratropium bromide.

Common Uses

Ipratropium bromide is indicated as a bronchodilator for maintenance treatment of bronchospasm associated with chronic obstructive pulmonary disease, including chronic bronchitis and emphysema. It may also be used to treat other conditions as determined by your doctor. It is administered either alone or with other bronchodilators, especially beta-adrenergics (albuterol). This solution can be mixed in the nebulizer with albuterol if used within one hour.

Instructions

Take ipratropium bromide exactly as prescribed by your doctor. Do not take it more frequently without your doctors approval. Excessive use may result in decreased efficacy and increased side effects. Store medication at room temperature, away from direct heat or sunlight. Rinse your mouth after each dose to help relieve dryness and throat irritation.

Onset, Peak, and Duration

Onset occurs within 5 to 15 minutes after inhalation. Peak effect occurs 1 to 2 hours after inhalation. Effects usually persist for 3 to 4 hours; up to 6 hours in some patients.

Missed Dose

Do not double dose if missed, but take it as soon as remembered. If it is almost time for your next dose, skip the missed dose and resume regular dosing schedule.

Side Effects

Possible side effects that may occur during treatment include dry mouth, irritated throat, dizziness, headache, heartburn, loss of appetite, restlessness, nervousness, trembling, and nausea may occur but should subside as your body adjusts to the medication. Chew gum or suck hard candy to relieve dry mouth. If these symptoms persist or worsen, Contact your doctor, nurse, or pharmacist.

Important Note

Inform your doctor if you experience chest pain, pounding heartbeat or breathing difficulties while taking this medication. If symptoms do not improve or worsen after taking this medication, call your doctor immediately. This medication SHOULD NOT BE USED DURING PREGNANCY unless clearly indicated UNDER DIRECT SUPERVISION OF YOUR PHYSICIAN.

Albuterol Sulfate

Albuterol sulfate (pronounced as “al-BYOO-ter-ole”) is an inhalation solution. Some of the brand names of albuterol sulfate include Proventil and Ventolin. This asthma medication belongs to the drug class of bronchodilators.

Common Uses

Albuterol sulfate relaxes the smooth muscle in the lungs and dilates airways to improve breathing. The inhaler enables the drug to reach deep into the lungs for maximum benefit. This medicine is a beta receptor stimulant used to treat or prevent the symptoms of asthma, exercise-induced asthma, emphysema, cardio-obstructive pulmonary disease and other breathing conditions as determined by your doctor.

Instructions

Take albuterol sulfate exactly as prescribed by your doctor. Do not take it more frequently without your doctors approval. Excessive use may result in decreased efficacy and increased side effects. Store medication at room temperature, away from direct heat or sunlight. Rinse your mouth after each dose to help relieve dryness and throat irritation.

Onset, Peak, and Duration

Onset of albuterol sulfate occurs within 15 minutes after inhalation. Peak effect occurs 1 to 1.5 hours after inhalation. Effects persist for 3 to 6 hours.

Missed Dose

Do not double dose if missed, but take it as soon as remembered. If it is almost time for your next dose, skip the missed dose and resume regular dosing schedule.

Side Effects

Possible side effects of albuterol sulfate that may occur during treatment include dry mouth, irritated throat, dizziness, headache, lightheadedness, heartburn, loss of appetite, altered taste sensation, restlessness, anxiety, nervousness, trembling, and sweating may occur but should subside as your body adjusts to the medication. Chew gum or suck hard candy to relieve dry mouth. If these symptoms persist or worsen, Contact your doctor, nurse, or pharmacist.

Important Note

Inform your doctor if you experience chest pain, pounding heartbeat or breathing difficulties while taking this medication. If symptoms do not improve or worsen after taking this medication, call your doctor immediately. This medication SHOULD NOT BE USED DURING PREGNANCY unless clearly indicated UNDER DIRECT SUPERVISION OF YOUR PHYSICIAN.

Aerosol Medications

If you have asthma, COPD (Chronic-Obstructive Pulmonary Disease), emphysema or other respiratory ailments, your doctor has probably prescribed one or more of these common types of aerosol medications or respiratory medicine. These aerosol medications can help relieve symptoms, making it easier for you to breathe and cope with your condition.

Understanding the Different Types of Aerosol Medications

Here’s a quick summary of what each type of aerosol medication does.

Bronchodilators

Bronchodilators are intended relieve reversible brochospasm by relaxing the smooth muscles of the bronchioles and open up airways in conditions associated with asthma, bronchitis, emphysema or bronchoiectasis. Examples of bronchodilators include albuterol, metaproterenol, and ipratropium.

Anti-Cholinergics

Anti-cholinergics produce bronchodilation by inhibiting cholinergic receptors on bronchial smooth muscles. Ipratropium Bromide is indicated for maintenance treatment of bronchospasm as associated with chronic obstructive pulmonary disease (COPD), including bronchitis and pulmonary emphysema.

Corticosteroids

Corticosteroids decrease inflammation of airways and reduce mucus production. They are used to help prevent the symptoms of asthma. When used regularly every day, they decrease the frequency and severity of asthma attacks. However, they will not relieve an asthma attack that has already started. Corticosteroids are sometimes prescribed along with bronchodilators. Examples of corticosteroids include betamethasone and dexamethasone.

See Corticosteroids (Oral) and Corticosteroids (Inhaled) for more information.

Antibiotics

Antibiotics help fight respiratory infections. They are often given at the first sign of nasal congestion, fever, increased coughing or a change in mucus. They work by killing bacteria and preventing their growth.

Expectorants-Mucolytics

Expectorants-mucolytics help loosen mucus and makes it easier to cough up. They are used to ease breathing in conditions such as bronchitis, emphysema, tuberculosis and other lung diseases.

Cromolyn

Cromolyn used as preventive to asthmatic reactions before contact or exposure with asthma triggers. When used regularly, cromolyn lessens the frequency and severity of asthma attacks by reducing inflammation in the lungs. Also used just before exposure to conditions and substances that cause bronchospasm (wheezing or difficultly in breathing). It will not help with asthma attacks that have already started. Intal is an example of cromolyn. See our cromolyn article for more information.

Important Reminder

When taking your medications. Be sure you are taking the right one and use the correct dose. Always follow directions from your physician carefully. Take medicines exactly as prescribed and at the intervals directed. Changing the size of doses or skipping doses can be dangerous.

Cromolyn Sodium

Cromolyn sodium is a unique medication with anti-inflammatory effects in the lungs. If taken regularly, it is capable of decreasing asthma symptoms. While it has no bronchodilator effect, when taken prior to exposure, it can effectively block the asthmatic response to allergens and exercise; thus preventing the inset of inflammation. Because it is well tolerated and has no know toxicities, it is often used for children though it is also effective for adults.

Brand Name

Intal
*Generic solutions are available

Drug Action

Cromolyn is capable of preventing the release of chemical mediators from mast cells and other cells causing an asthmatic inflammation. Blocking the release of these mediators reduces the inflammation and airway hyperreactivity. In this way, Cromolyn effectively decreases asthma symptoms and improves lung function.

Side Effects

Cromolyn is essentially free of side effects.

Available Forms

Cromolyn must be inhaled to be effective in asthma. In most cases it can be administered two to four times daily. It is available as metered dose inhaler or as a clear liquid in vials for nebulization. It can be mixed with other nebulized medications. Other forms include eye drops and nasal spray for eye and nasal allergy.

Indications

As an asthma controller, Cromolyn is inhaled two to four times daily. For prophylaxis of exercise induced or allergic asthma, Cromolyn can be used up to thirty minutes prior to exposure.

Additional Comments

  • Cromolyn is not effective once allergen exposure or exercise has begun. Benefits of Cromolyn for exercise induced asthma fall off quickly after thirty minutes, so timing is important.
  • Cromolyn can also be taken before a known allergy season. For example, if one has particular trouble with ragweed, Cromolyn can be started prior to ragweed season (per physician recommendation) and stopped at the end of the season.
  • Cromolyn will not give relief in an acute asthma attack but should be continued during an asthma exacerbation, if tolerated.

Corticosteroids (Inhaled)

Chronic inflammation is the major component of persistent asthma. Corticosteroids are remarkably effective in suppressing the inflammation of asthma, thereby, controlling the disease. The development of inhaled corticosteroids is one of the greatest advancements in the treatment of asthma. Often, it is the only medication required on a daily basis.

Brand NameGeneric Name
Aerobid and Aerobid MFlunisolide
AzmacortTriamcinolone acetonide
BecloventBeclomethasone dipropionate
Vanceril D. S.Beclomethasone dipropionate
FloventFluticasone propionate

 

Drug Action

Corticosteroids decrease inflammation of the airways. The inhaled form acts directly on the airways and has little effect on the rest of the body when taken in the usual prescribed doses.

Side Effects

  • Minor fungal infections (thrush) in the mouth and throat can occur. This can usually be prevented by using a spacer device and rinsing the mouth after use.
  • Cough, hoarseness and throat irritation are other side effects seen occasionally. Using a spacer device can also minimize these side effects.

Indications for Use

  • As a preventative medicine when used routinely.
  • Can be used to decrease the amount of oral corticosteroids required for the treatment of asthma.

Additional Comments

  • These drugs do not have a bronchodilator effect and do give immediate relief of symptoms.
  • Inhaled corticosteroids also come in a nose spray for the treatment of allergies and sinusitis.

Beta 2 Agonists

Beta 2 agonists are bronchodilators. They relax smooth muscles around the bronchial tubes allowing air to move more freely. There are many of these preparations available and all work in a similar fashion. These are the medications of choice to treat and control asthma symptoms and are often taken in conjunction with other medications, particularly inhaled corticosteroids.

They are available as short-acting medications as well as more long-acting ones. In general, these medications are well tolerated and are very effective.

Brand NameGeneric Name
AlupentMetaproterenol
BrethineTerbutaline
BronkosolIsoetharine
MaxairPirbuterol acetate
Proventil MDI Albuterol
Proventil HFA
Albuterol
Serevent (long acting) Salmeterol xinafoate
TornalateBitolterol mesylate
VentolinAlbuterol
VolmaxAlbuterol
CombiventAlbuterol and Atrovent

Drug Action

Beta 2 agonists relax bronchial smooth muscles but also stimulate the heart muscle as well as skeletal muscles.

Side Effects

Beta 2 agonists are well-tolerated by most people and the side effects decrease with time. The inhaled form is the most effective and causes the least side effects. The most common side effects are:

  • Fast heartbeat
  • Tremors, nervousness
  • Difficulty sleeping

Available Forms

The preferred form of administration of Beta Agonist is by inhalation. Tablets and elixirs are available. The inhaled Beta Agonist may be given by nebulization, metered dose inhalers, or inhaled powered forms. Careful understanding of the correct techniques of inhalation is very important.

The short-acting medications begin to work in minutes and last 4 to 6 hours. The longer acting medication (Salmeterol) does not have a rapid onset of action. Salmeterol (Serevent) will last up to 12 hours but should not be used for acute bronchospasm or wheezing. Salmeterol has not been approved for patients under the age of 12. Both long and short-acting Beta Agonist can be used to prevent exercised induced asthma. Specific use of these medications should be directed by the physician and careful guidelines and understanding of the use of these medications are important.

Antihistamines

Antihistamines may have some beneficial effects in the treatment of asthma. Their benefits, however, are very small compared with more established medications. Therefore, Antihistamines are not recommended specifically for asthma treatment.

Many individuals with asthma may experience symptoms of nasal allergy for which antihistamines are very helpful. Furthermore, antihistamines are considers generally safe for asthmatics.

Antihistamines can be divided into two groups: the older “classic” antihistamines, many of which are available without a prescription, and the newer “second generation” or “non-sedating” antihistamines which have fewer side effects. Both the “classic” and “second generation” antihistamines are available in combination with decongestants.

Classic Antihistamines

Non-Prescription Prescription
Benadryl Atarax
ChlorTrimeton Nolahist
Dimetane Optimine
Efidac PBZ
Tavist Periaction
Teldrin Phenergen
Polyhistine
Temaril
Vistaril

Classic Antihistamine-Decongestants

Non-Prescription Prescription
Actifed Atrohist
Allerest Bromfed
Contac Comhist
Dimetapp Extendryl
Drixoral Kronafed
Isoclor Rynatan
Tavist-D Rutuss
Trinalin

Second Generation Antihistamines

These second generation antihistamines include non-sedating and antihistamine-decongestant combinations (by prescription only).

Allegra
Allegra-D (with decongestant)
Claritin
Claritin-D (with decongestant) 12 &24 hr
Hismanal
Zyrtec
Claritin Repetabs
Claritin Syrup
Semprex —D

Drug Action

Antihistamines block the effects of histamine. They reduce runny nose, sneezing and itching. They are not very effective for nasal stuffiness; these symptoms can be reduced by decongestants.

Side Effects

The most common side effect of classic antihistamines is drowsiness. Other side effects include dry mouth and eyes, stomach upset and decreased urination. The side effects are rarely seen with Second Generation antihistamines. Decongestants may cause irritability, shaking, insomnia, palpitations and stomach upset.

Available Forms

The medications are taken orally, in pill, capsule or liquid forms. Some antihistamines are available for injection. A nasal spray, Astelin is now available.

Indications for Use

These medications are indicated primarily for the treatment of allergic rhinitis to reduce runny nose, sneezing and itching. They are also used to treat hives and other allergic skin conditions.

Contraindications and Precautions

Because many antihistamines cause drowsiness, they should be used cautiously in combination with other sedating medicines and should not be taken with alcohol. Antihistamines may worsen certain forms of glaucoma and may lead to decreased urination in men with enlarged prostates. Decongestants may elevate blood pressure in some individuals and cannot be taken by persons on MAO inhibitor antidepressants.

The second generation antihistamine, Hismanal has been shown to cause irregular heart rhythms and even death when taken either in higher than recommended doses or in combination wit other medications, such a antibiotics, Erythromycin, Biaxin or the anti-fungal drugs, Fluconazole, Metronidazole, Ketoconazole and Itraconazole. Hismanal could also cause irregular heart rhythms in individuals with liver disease. Therefore, if you take Hismanal you must be certain that you do not take more than the recommended dose and that you do not take any other interacting medications. Consult your physician regarding this concern.

Anticholinergics

Anticholinergics are drugs have been used for centuries in herbal remedies for asthma, but their side effects were unacceptable. Recently, there has been renewed in this group of drugs. Atrovent is an inhaled anticholinergic preparation that is not absorbed in to the circulation and therefore does not cause unacceptable side effects.

Brand Names Generic Names

Atrovent Ipratropium bromide
Combivent Atrovent and Albuterol

Drug Action

Anticholinergics partially block the vagus nerve, which normally controls the slightly constrictive nature of the airways. This results in relaxation and opening of the airways.

Side Effects

Atrovent usually causes no side effects.

Available Forms

Metered dose inhaler, nebulizer solution and nasal spray.

Corticosteroids (Oral)

Asthma is an inflammatory disease and since oral steroids are the most effective anti-inflammatory agent, they are particularly effective in the treatment of asthma. Despite their effectiveness, oral corticosteroids carry the risk of side effects if taken long term. They should only be used in acute exacerbations and for those who have failed inhaled steroids. In general, for acute asthma, the benefit of corticosteroids far outweigh the potential risks and can be life saving.

Brand Names

  • Decadron
  • Deltasone
  • Dexamethasone
  • Liquid Pred
  • Medrol
  • Orasone
  • Pediapred
  • Prednisolone
  • Prednisone
  • Prelone

Drug Action

Corticosteroids decrease inflammation in the airways. This effect may begin within hours and is secondary to a decrease in the inflammatory cells in the airways.

Potential Side Effects

  • Increased appetite/weight gain
  • Cataracts
  • Osteoporosis (weakening of the bones); can cause growth retardation in children
  • Fullness of the face (moonface)
  • Elevated blood pressure
  • Muscle weakness
  • Changes in fat distribution
  • Skin changes such as acne
  • Bruising more easily
  • Salt and fluid retention
  • Less resistance to infection
  • Diabetes mellitus
  • Suppression of normal corticosteroid production
  • Menstrual disorders
  • Severe chicken pox reaction

If the individual has not had the chicken pox, and are exposed to them while taking oral corticosteroids, they need to notify their physician immediately. The physician may want to alter the steroid dose to prevent severe infection from developing.

Available Forms

Liquids can be mixed with something sweet to be better tolerated; their action becomes effective in 4 to 6 hours. Tablets are also effective for 4 to 6 hours. Intravenous injections can be given in the hospital setting.

Additional Comments

  • Oral corticosteroids should be taken as directed by your physician. There is some evidence that 3PM dosing may be the most effective.
  • Oral corticosteroids may be used in early treatment of acute asthma exacerbations to prevent severity of attack.
  • Corticosteroid doses need to be increased at times of increased physical stress such as surgery. If presently utilizing or if taken regularly within six months of surgery, additional corticosteroids will be needed at the time of surgery, to prevent potential complications. A calcium supplement may be necessary when on long-term oral corticosteroids.
  • The dose of oral corticosteroids should be decreased gradually by those taking corticosteroids for a prolonged time because the adrenal glands (glands responsible the making the body’s natural corticosteroids) take time to resume their production.