Anticholinergics for asthma

Examples

Combination of an anticholinergic (ipratropium) and a short-acting beta2-agonist (albuterol):

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 medication used. Always consult 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. 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.

Medication 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 than 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 dose of medicines that work best.

How Well It Works

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

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 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.

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.

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