Anticholinergics for asthma

Examples

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The following medication combines an anticholinergic and a short-acting beta₂-agonist.

Brand Name	Chemical Name
DuoNeb	ipratropium bromide and albuterol sulfate

Ipratropium bromide alone and combined with albuterol sulfate 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 medication used. Always consult the directions to be sure you are using the inhaler correctly.

How It Works

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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

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Inhaled anticholinergics are usually used for severe asthma attacks. Although they are sometimes used in the home, they are not used as daily maintenance treatment for persistent asthma, and they are always used with another medication.

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 medication used after short-acting beta₂-agonists during an asthma attack. The combination may relieve symptoms for a longer period of time.

See information on:

• Asthma medications for adults, teens, and children older than age 5.
• Asthma medications for children age 5 and younger.

How Well It Works

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A review of research indicates 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.
• Improves lung function when also combined with an inhaled corticosteroid.

Side Effects

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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

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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 health professionals 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 medication to the lungs better than an inhaler alone, and for many people is easier to use than an MDI alone.

Try to avoid giving your child an inhaled medication when he or she is crying; in this case, not as much medication is delivered to the lungs.

Complete the new medication information form (PDF) (What is a PDF document?) to help you understand this medication.

References

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Citations

1. Dennis RJ, et al. (2005). Asthma, search date May 2004. Online version of Clinical Evidence (14): 1847–1877.

2. Keeley D, McKean M (2006). Asthma and other wheezing disorders in children, search date October 2004. Online version of Clinical Evidence (15): 1–25.

Credits

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Author	Maria G. Essig, MS, ELS
Editor	Susan Van Houten, RN, BSN, MBA
Associate Editor	Denele Ivins
Primary Medical Reviewer	Michael J. Sexton, MD - Pediatrics
Specialist Medical Reviewer	Harold S. Nelson, MD - Allergy and Immunology
Last Updated	March 22, 2007