|Generic Name||Brand Name|
Prescription anticholinergic and short-acting beta2-agonist combination
|Generic Name||Brand Name|
|ipratropium and albuterol||Combivent, DuoNeb|
Ipratropium alone and combined with albuterol
is available in metered-dose
inhaler (MDI) and
nebulizer forms. One medicine may be available in
multiple forms. Your doctor will help you decide which form is best for
Tiotropium is available only in dry powder form for
inhalation in a
There are two types of
anticholinergics: short-acting and long-acting. The short-acting type relieves
symptoms and the long-acting type helps prevent breathing problems.
Short-acting anticholinergics are used for treating stable COPD in a person
whose symptoms come and go (intermittent symptoms). Long-acting
anticholinergics are effective and convenient for preventing and treating COPD
in a person whose symptoms do not go away (persistent symptoms).
How It Works
Anticholinergics relax and enlarge
(dilate) the airways in the lungs, making breathing easier (bronchodilators). 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.
Why It Is Used
Anticholinergics generally are
considered first-line therapy for treating persistent symptoms of
chronic obstructive pulmonary disease (COPD). Because
these medicines may take some time to have an effect on breathing, they usually
are taken on a regular schedule. They are used for both short- and long-term
relief of symptoms.
How Well It Works
A number of studies show that
inhaled anticholinergics improve lung function as measured by tests (spirometry). They also reduce the number of
Studies have shown that:5
- In short-term treatment, ipratropium and
tiotropium both improved lung function compared to a
- After one year of treatment,
tiotropium improved lung function and reduced the number of
COPD exacerbations and hospital admissions, compared
to a placebo.
Combining an anticholinergic with a beta2-agonist may help
your lung function more than using either medicine alone.5 Combining medicines also may reduce the risk of side effects compared to increasing the dose of one medicine.6
Compared to tiotropium alone,
combining tiotropium with a beta2-agonist (salmeterol) and corticosteroid
(fluticasone) improved lung function and quality of life and lowered the number
of hospital visits.4
A mild cough and dry mouth are the most
common side effects.
There have been rare reports of
closed-angle glaucoma after using inhaled ipratropium.
Call your doctor immediately if an eye becomes red or painful or if you have
misty vision after using this medicine.
Some studies suggest that inhaled anticholinergic medicines increase the risk of heart attack or stroke.2 But other studies indicate that the medicines lower that risk.3 If you are concerned about this risk, talk to your doctor.
See Drug Reference for a
full list of side effects. (Drug Reference is not available in all
What To Think About
are regarded as the first-line treatment for the persistent symptoms in most
cases of COPD. But short-acting beta2-agonists may be the first choice for treating
symptoms of stable COPD that come and go (intermittent symptoms).
Spirometry may be done before and after you try an
anticholinergic for the first time to see whether the medicine has had an
effect. But even if the medicine has no measurable effect on your lung
function, it still may improve your quality of life.
normally are no better at delivering anticholinergics deep into the lungs than
a properly used metered-dose inhaler. Sometimes your doctor may prescribe a
nebulizer. Although a nebulizer can deliver a very large dose of medicine, it
also may increase side effects of the medicine.
Tiotropium is to
be used only with a
HandiHaler, a type of dry powder inhaler.
Most doctors recommend that everyone using a metered-dose inhaler also
use a spacer . But you should not use a spacer with a dry
powder inhaler (DPI).
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
Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.
Tashkin DP, et al. (2008). A 4-year trial of tiotropium in chronic obstructive pulmonary disease. New England Journal of Medicine, 359(15): 1543-1554.
Singh S, et al. (2008). Inhaled anticholinergics and risk of major adverse cardiovascular events in patients with chronic obstructive pulmonary disease: A systematic review and meta-analysis. JAMA, 300(12): 1439-1450.
Celli B, et al. (2010). Cardiovascular safety of tiotropium in patients with COPD. Chest, 137(1): 20-30.
Aaron SD, et al. (2007). Tiotropium in combination
with placebo, salmeterol, or fluticasone-salmeterol for treatment of chronic
obstructive pulmonary disease. Annals of Internal Medicine, 146(8): 545-555.
Kerstjens H, et al. (2005). Chronic
obstructive pulmonary disease. Clinical Evidence (13):
Global Initiative for Chronic Obstructive
Lung Disease (GOLD) (2005). Executive summary (updated 2005). In
Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease. Available online: