Anticholinergics for Asthma

Example(s): Atrovent (ipratropium),Combivent,DuoNeb (ipratropium and albuterol)

Anticholinergics for Asthma


Generic Name Brand Name
ipratropium Atrovent

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

Generic Name Brand Name
ipratropium and albuterol Combivent, DuoNeb

Ipratropium alone and combined with albuterol is available
in metered-dose
inhalers (MDI) and as a liquid form for use in
nebulizers. Inhalers may be used differently,
depending on the medicine used. Always read 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

Why It Is Used

Inhaled anticholinergics are usually
used for severe
asthma attacks. They are sometimes used in the home,
but they are not used as daily maintenance treatment for persistent
asthma. And they are sometimes used with another

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

Medicine treatment for asthma depends on a person’s age,
his or her type of asthma, and how well the treatment is controlling asthma

  • Children up to age 4 usually are treated a
    little differently from 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
  • 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
doses of medicines that work best.

How Well It Works

A review of research shows that
combining ipratropium with a short-acting beta2-agonist:footnote 1, footnote 2

  • Improves lung function compared to using a
    short-acting beta2-agonist alone.
  • Reduces hospital admission for
    adults and children with severe asthma attacks.

Side Effects

All medicines have side effects. But many people don’t feel the side effects, or they are able to deal with them. Ask your pharmacist about the side effects of each medicine you take. Side effects are also listed in the information that comes with your medicine.

Here are some important things to think about:

  • Usually the benefits of the medicine are more important than any minor side effects.
  • Side effects may go away after you take the medicine for a while.
  • If side effects still bother you and you wonder if you should keep taking the medicine, call your doctor. He or she may be able to lower your dose or change your medicine. Do not suddenly quit taking your medicine unless your doctor tells you to.

Side effects are rare with inhaled
ipratropium but may include:

  • Dry mouth.
  • Increased
  • 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, such as ipratropium, are sometimes used with albuterol for severe asthma attacks.

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 medicine to the lungs better than an inhaler alone. And for many
people a spacer is easier to use than an MDI alone.

Try to avoid
giving your child an inhaled medicine when he or she is crying, because not as
much medicine 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.

Taking medicine

Medicine is one of the many tools your doctor has to treat a health problem. Taking medicine as your doctor suggests will improve your health and may prevent future problems. If you don’t take your medicines properly, you may be putting your health (and perhaps your life) at risk.

There are many reasons why people have trouble taking their medicine. But in most cases, there is something you can do. For suggestions on how to work around common problems, see the topic Taking Medicines as Prescribed.

Advice for women

If you are pregnant, breastfeeding, or planning to get pregnant, do not use any medicines unless your doctor tells you to. Some medicines can harm your baby. This includes prescription and over-the-counter medicines, vitamins, herbs, and supplements. And make sure that all your doctors know that you are pregnant, breastfeeding, or planning to get pregnant.


Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It’s also a good idea to know your test results and keep a list of the medicines you take.

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



  1. Rodrigo G (2011). Asthma in adults (acute), search date April 2010. BMJ Clinical Evidence. Available online: ://
  2. Okpapi A, et al. (2012). Asthma and other recurrent wheezing disorders in children (acute), search date June 2010. BMJ Clinical Evidence. Available online: ://


ByHealthwise StaffPrimary Medical Reviewer John Pope, MD – Pediatrics E. Gregory Thompson, MD – Internal Medicine Adam Husney, MD – Family Medicine Specialist Medical Reviewer Elizabeth T. Russo, MD – Internal Medicine

Current as ofDecember 6, 2017