- Combivent Inhaler for Asthma Control
- Combivent Respimat (ipratropium bromide and albuterol)
- What are the ingredients in Combivent Respimat?
- How does Combivent Respimat work?
- What are the possible side effects of Combivent Respimat?
- Things to know about Combivent Respimat
- Dosing information
- Bronchodilators & Asthma
- Asthma Medicine: Finding What Works Best For You
- Traditional Medicine
- First-line Medicine
- Rescue Medicine
- Controller Medicine
- Second-line Medicine
- Adjunct Medicine
- Alternative Medicine
- Non-Traditional Treatment
Combivent Inhaler for Asthma Control
People who do not get sufficient relief from their asthma symptoms with a single bronchodilator that contains one fast-acting medication have the option of using a Combivent inhaler, which combines two medications in one inhaler. The Combivent inhaler, containing both albuterol and ipratropium, is primarily used by people with chronic obstructive pulmonary disease (COPD), but it may offer some benefit to people with more severe asthma, though it is not considered standard treatment for asthma.
Are you doing everything you can to manage your asthma? Find out with our interactive checkup.
Combivent Inhaler: How it Works
“As the name implies, the Combivent inhaler is a combination of ingredients — a beta-2 agonist and another drug that acts on a different part on the pathways that control asthma,” explains Richard Castriotta, MD, professor of medicine and associate director of the Division of Pulmonary, Critical Care, and Sleep Medicine at the University of Texas Houston Medical School.
“In general, this group of drugs not as powerful nor as quick-acting as the beta-2 agonists,” he says. “It doesn’t take effect within 10 minutes the way albuterol does. It may take an hour or two before you really have effects.”
Combivent Inhaler: Who May Benefit
Although some people can use their Combivent inhaler as a “rescue” inhaler, Dr. Castriotta says it might not act quickly enough. Instead, Combivent is considered an addition to the treatment regimen for people with severe or chronic asthma. “Combivent is usually prescribed as a maintenance drug, usually in people who have COPD,” he says. “People with COPD usually don’t have a good response to a bronchodilator” such as albuterol.
According to the National Heart, Lung, and Blood Institute, anticholinergic ipratropium, one of the key ingredients in this combination drug, might be an alternative for you if albuterol is not effective alone.
Combivent Inhaler: Warnings and Side Effects
Combivent should only be used as prescribed, basically for the relief of occasional symptoms. An overdose can be fatal. If you use the Combivent dosage your doctor prescribed and do not get relief, contact the doctor right away.
Be sure to discuss your use of a Combivent inhaler with your health care provider if you have any of the following conditions, as Combivent may make them worse:
- Abnormal heart rhythm
- Enlarged prostate
- Epilepsy or other seizure disorder
- Heart disease or congestive heart failure
- Liver or kidney disease
- Overactive thyroid
Call your doctor if you have the following side effects while using Combivent:
- Chest pain
- Pain in your left arm
- Pounding heart
- Tight chest
New Inhalers: What You Should Know
Beginning in 2009, inhalers got a new look — a change mandated by law in an effort to protect the ozone layer. No longer can inhalers use chloroflourocarbons, known as CFCs, as the propellant that gets the medication into your lungs; instead, only hydroflouroalkane, or HFA, can be used going forward. That’s good for the environment because HFA does the same job at less cost to the ozone layer. But it means some changes in how you use your inhaler, too.
Talk to your doctor about using the new inhaler design, but know that you will need to make an extra effort to:
- Prime your inhaler when you use it.
- Inhale with more force to get your medication.
- Clean your mouthpiece more thoroughly.
Combivent may help relieve some of the symptoms of severe asthma. If you use, or are planning to use, a Combivent inhaler, make sure that you have thorough knowledge of how it works and that you and your doctor evaluate whether it truly benefits you.
Combivent Respimat (ipratropium bromide and albuterol)
Combivent Respimat (ipratropium bromide and albuterol) is a combination of two fast-acting medications that is used to provide immediate, short-term relief from COPD exacerbations and COPD symptoms. Specifically, Combivent Respimat combines an anticholinergic medication with a short-acting beta2-adrenergic agonist (sometimes referred to as a SABA) to provide relief from COPD symptoms in adults who are currently utilizing a regular aerosol bronchodilator but are still experiencing exacerbations or bronchospasms. The medication is administered orally through an inhaler that can be taken up to four to six times a day. Those who experience a worsening of symptoms or difficulty breathing after taking Combivent Respimat should stop taking the medication immediately. Individuals with a history of cardiovascular conditions, urinary conditions, or vision problems should be monitored carefully if taking Combivent Respimat.
What are the ingredients in Combivent Respimat?
The active ingredients in Combivent Respimat are ipratropium bromide, the anticholinergic medication, and albuterol, the short-acting beta2-adrenergic agonist.
How does Combivent Respimat work?
Combivent Respimat is a combination medication that includes an anticholinergic drug and a SABA. Both of these together work to provide short-term relief from COPD symptoms or exacerbations. The anticholinergic, ipratropium bromide, is a bronchodilator and blocks acetylcholine receptors in the body. Acetylcholine is a neurotransmitter that plays a role in muscle contraction, meaning it passes signals from one nerve cell to another and tells the body how it’s muscles should react. When acetylcholine receptors are blocked, smooth muscles, like those in the airways, can relax. This smooth muscle relaxation can reduce the number of bronchospasm and open the airways.
Albuterol is a short-acting beta2-adrenergic agonist. This means that it quickly activates beta2-adrenergic receptors in the body. Activation of these receptors sets off a chain of events in the body that also leads to smooth muscle relaxation. Although the albuterol relaxes the smooth muscles in a different way than the ipratropium bromide, both mechanisms can work together to provide relatively fast short-term relief from bronchospasms and COPD exacerbations. Since they are relatively quick acting and do not take the place of maintenance (long-term) therapies, medications like Combivent Respimat are often referred to as rescue therapies.
What are the possible side effects of Combivent Respimat?
Many clinical trials evaluated the safety and efficacy of Combivent Respimat. The most common side effects experienced by those taking Combivent Respimat include:
- Upper respiratory infection
- Cold or cold-like symptoms (nasopharyngitis)
- Trouble breathing
This is not an exhaustive list of all potential side effects of Combivent Respimat. For more information, consult your doctor or healthcare provider. If you notice any new or worsening side effects, contact your doctor or healthcare provider immediately.
Things to know about Combivent Respimat
Individuals with the following conditions should be monitored closely while taking Combivent Respimat:
- Cardiovascular disorders
- Urinary retention issues or other urinary conditions including prostatic hyperplasia or bladder-neck obstruction
- Eye problems, including narrow-angle glaucoma
- Convulsive disorders
- Diabetes mellitus
If bronchospasms or breathing worsen after taking Combivent Respimat, discontinue the medication immediately. Individuals taking Combivent Respimat should also be monitored for hypersensitivity or allergic reactions to ingredients of Combivent Respimat. If your symptoms worsen after you take Combivent Respimat, or you believe you are having an allergic reaction, seek immediate medical attention. Before starting Combivent Respimat, tell your doctor about any medical conditions you may have, as well as any medications, vitamins, or supplements you may be taking, as some medications may interact with Combivent Respimat.
The medication is administered orally through an inhaler, the Combivent Respimat inhaler, and can be taken up to four to six times a day. Each dosage has 20mcg of ipratroprium bromide and 100mcg of albuterol. No more than six inhalations can be taken within a 24-hour period. Detailed instructions on how to use the Combivent Respimat are located in the prescribing information for the medication. Alternatively, your doctor or a healthcare team member may show you how to use the inhaler.1
For more information, read the full prescribing information of Combivent Respimat.1
Bronchodilators & Asthma
What are bronchodilators?
Bronchodilators relieve asthma symptoms by relaxing the muscle bands that tighten around the airways. This action rapidly opens the airways, letting more air come in and out of the lungs. As a result, breathing improves. Bronchodilators also help clear mucus from the lungs. As the airways open, the mucus moves more freely and can be coughed out more easily.
There are two forms of bronchodilators:
- Short-acting bronchodilators_ relieve or stop _asthma symptoms; you take these to stop an asthma attack.
- Long-acting bronchodilators help _control _asthma symptoms by keeping the airways open for 12 hours; this helps prevent asthma attacks.
There are two main types of bronchodilator medicines:
- Beta 2-agonists (short and long-acting forms)
Short-acting Beta 2-agonists inhaled medicines include:
- Albuterol (Proventil® HFA, Ventolin® HFA, ProAir®HFA, Accuneb®)
- Levalbuterol (Xoponex® HFA, Xoponex® nebulizer solution)
- Albuterol and ipratropium bromide combination (DuoNeb® solution, Combivent Respimat®)
Short-acting beta 2-agonists are called “reliever” or “rescue” medicines because they stop asthma symptoms very quickly by opening the airways. These are the best medications for treating sudden and severe or new asthma symptoms. They work within 15 to 20 minutes and last four to six hours. They are also the medicines to use 15 to 20 minutes before exercise to prevent exercise-induced asthma symptoms. If you need to use your short-acting beta 2-agonists more than twice per week, talk to your doctor. This is a sign of unstable asthma and your doctor may want to change the dose of the long-term control medicines you take.
Beta 2-agonists – Long-acting forms include:
- Salmeterol (Serevent®)
- Formoterol (Foradil®)
- Combination medications: salmeterol and fluticasone (Advair®); formoterol and budesonide (Symbicort®); formoterol and mometasone (Dulera®). These contain both the long-acting beta agonist and an inhaled corticosteroid.
Salmeterol and formoterol are the only inhaled long-acting beta 2-agonists available. They are used twice a day to maintain open airways for long-term control and they must be used with an inhaled corticosteroid for the treatment of asthma. They have also been shown to be helpful in treating exercise-induced asthma. They are available in dry powder inhaler (DPI) form.
Side effects of beta 2-agonists include:
- Nervous or shaky feeling
- Overexcitement or hyperactivity
- Increased heart rate
- Upset stomach (rare)
- Trouble sleeping (rare)
Albuterol also is available in pills or syrups. These medicines tend to have more side effects because they are in higher doses and are absorbed through the bloodstream to get to the lungs. Inhaled forms are preferred because they are deposited directly in the lungs and therefore have fewer side effects.
There are two anticholinergic bronchodilators currently available — ipratropium bromide (Atrovent® HFA), which is available as a metered dose inhaler and nebulizer solution, and tiotropium bromide (Spiriva®), which is a dry powder inhaler. Ipratropium is used four times per day. Tiotropium is used only once per day and lasts 24 hours. It should be used at the same time every day. These are not quick-relief medications but they can add to the bronchodilator effect for certain asthmatics with difficult-to-control symptoms.
Side effects are minor; dry throat is the most common. If the medicine gets in your eyes, it might cause blurred vision for a short period of time.
Theophylline is another type of bronchodilator that is used to control asthma. Brand names include Uniphyl®, Elixophyllin®, Theochron and Theo-24®. Theophylline is available as a pill or as an intravenous (through the vein) drug. It is long-acting and prevents asthma attacks. Theophylline may be used to treat difficult-to-control or severe asthma and must be taken daily. When taking theophylline, blood tests are needed to make sure you are receiving the right amount of medicine.
Side effects include:
- Nausea and/or vomiting
- Stomach ache
- Rapid or irregular heartbeat
- Muscle cramps
- Jittery or nervous feeling
These side effects might be a warning of too much medicine. Call your doctor if you have any of these side effects. Tell all your doctors if you take theophylline for asthma because certain medicines —such as antibiotics containing erythromycin, or seizure and ulcer medicine—can interfere with the way theophylline works. Also, viral illnesses and cigarette smoking can change how your body responds to theophylline.
It is important to remember that asthma is a chronic (meaning always there) disease of the airways. Treatment with the right medications leads to better asthma control. Always follow the medication plan you have been given. If your asthma medicines are not controlling your symptoms or if you have any other questions make sure you contact your doctor. Remember that although asthma cannot be cured, it can be controlled by working with your doctor to find the care plan that is best for you.
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Asthma Medicine: Finding What Works Best For You
There are various terms describing asthma medicines. Here I will define these terms for you, along with what asthma medicines they are referring to. Ideally, this should give you an idea of what medicines are available to you and your doctor in your quest to obtaining ideal asthma control.
These are medicines that are scientifically proven safe and effective for preventing and controlling asthma. They are approved by the FDA, recommended by asthma guidelines, and prescribed by physicians as standard asthma treatments.
These are referred to as top-line, front-line, standard, or traditional asthma medicines. These are usually the first medicines prescribed once a diagnosis of asthma is made. They help most asthmatics treat, prevent, and control their asthma. They include rescue medicine and controller medicine.
These are medicines that act to quickly open airways to relieve asthma symptoms and end asthma attacks. Most asthma experts recommend that all asthmatics have a prescription for a rescue medicine, and that they keep it nearby at all times. They include:
- Short Acting Beta-2 (B2) Adrenergic (SABA) Inhalers These are inhaled medicines that attach to B2 adrenergic receptors lining your air passages to open airways and make breathing easier. They usually work fast, which is why they are often called rescue medicines, although they are short acting, usually lasting 4-8 hours. These include albuterol (Ventolin, ProAir, Proventil) and levalbuterol (Xopenex).
These are medicines that are taken every day to prevent and control asthma. They are also referred to as asthma maintenance medicines. They include:
- Inhaled corticosteroids These inhalers contain a low dose of corticosteroids that, once inhaled, attach to cells lining airways to reduce airway inflammation. This makes your airways less sensitive to asthma triggers to prevent asthma attacks, or make them less severe when they do occur. These include fluticasone (Flovent HFA, Arnuity Ellipta), beclomethasone (Qvar), flunisolide (Aerospan), ciclesinide (Alvesco HFA), mometasone (Azmanex HFA, Azmanex Diskus), and budesonide (Pulmicort Flexhaler).
- Inhaled corticosteroid/ Long-Acting B2 Adrenergic Combination Inhalers. These are inhalers that contain an inhaled corticosteroid and a LABA. LABA’s are B2 adrenergic medicines that last 12-24 hours. They are given in conjunction with an inhaled corticosteroid to keep airways open long term. They are what is prescribed when inhaled corticosteroids alone do not result in optimal asthma control. Examples include: fluticasone/ salmeterol (Advair Diskus, Advair HFA), fluticasone/ vilanterol (Breo Ellipta), mometasone/ formoterol (Dulera), and budesonide/ formoterol (Symbicort HFA)
These are also considered traditional asthma medicines, although they are usually referred to as add-ons or adjunct medicines. They include:
- Leukotriene Modifiers. They block the effects of leukotrienes, which are chemicals released during the asthma/ allergy response that cause allergy and asthma symptoms. Examples include montelukast (Singulair), zafirlukast (Accolate), and zileuton (Zyflo).
- Anticholinergics They block the effects of acetylcholine, which is a neurotransmitter that causes bronchoconstriction. Examples include ipatropium bromide (Atrovent HFA), glycopyrrolate, (Seebri Neohaler), umeclidinium (Incruse Ellipta), tiotropium bromide (Spiriva HandiHaler), (Spiriva Respimat), and aclidinium bromide (Tudorza Pressair).
- Anticholinergic/ B2 Adrenergic Combination Inhalers These include ipatropium bromide/ albuterol (Combivent Respimat).
- Combination Anticholinergic/ LABA Inhalers These include umeclidinium/ vilanterol (Anoro Ellipta), tiotropium bromide/ olodaterol (Stiolto Respimat), and glycopyrrolate/ indacaterol (Utibron Neohaler).
- LABA Inhalers These are not generally recommended for use with asthma without also using an inhaled corticosteroid. However, they are still options. These include salmeterol (Serevent Diskus), indacaterol (Arcapta Neohaler), and olodaterol (Striverdi Respimat).
- Methylxanthines These are little white pills that were considered first-line asthma medicines back in the 1970’s and 80’s. They are good bronchodilators, although they also appear to have some anti-inflammatory properties. Today they are considered as second-line, adjunct, or alternative medicines mainly because of side effects and due to better medicines on the market today for controlling asthma. The most common one prescribed here is theophylline. They have been around for a long time, so there are various generic products available.
- Systemic Corticosteroids These are corticosteroids that are taken orally and can be used to reduce airway inflammation to control acute asthma episodes. Usually you are given a bolus dose on the first day, and then you are weaned off them over the course of several days. To reduce your risk for side effects, your doctor will usually try to keep the dose as low as possible, and the duration as short as possible. Examples include methylprednisolone, prednisolone, and prednisone.
- Biologics (Immunomodulators, monoclonal antibodies). These are medicines that block the effects of certain immune cells and chemicals responsible for asthma and allergy symptoms. Examples include omalizumab (Xolair), mepolizumab (Nucala) and reslizumab (Cinqair).
These are second-line medicines that are used in conjunction with first-line medicine, especially when first-line medicines do not result in ideal asthma control. An example here is when an allergic asthmatic is prescribed Advair and Albuterol yet still has allergy symptoms. A good adjunct therapy here might be Singulair.
These are second-line medicines that are used instead of first-line medicines in an effort to obtain ideal asthma control. A good example here is prescribing Singulair to control asthma in a person who has exercise-induced asthma. In some individuals, Singulair alone might work for this.
These are asthma treatments that are not well studied and therefore not generally recommended by the medical profession. However, some asthmatics find they are used as alternatives to, or adjuncts with, traditional asthma medicines. They include changing your diet to include certain vitamins, minerals, and supplements. Halotherapy (salt therapy), breathing exercises (Yoga, Buteyko), acupuncture, chiropractic services, and homeopathy are also included here.
These are medicines that are currently being developed or studied to see if they are viable and safe treatments for asthma. At the present time, there are a variety of asthma medicines in the pipeline, including the biologics benralizumab, ligelizumab, tralokinumab, lebrikizumab, dupilumab, and dectrekumab.
Once you have a diagnosis of asthma, and once your doctor determines you might benefit from asthma medicines, finding which medicine or medicine combinations work best for you is usually a matter of trial and error.