The combination albuterol–ipratropium (brand name, Combivent Respimat; Boehringer-Ingelheim) is a short-acting bronchodilator for people with COPD whose symptoms are not controlled by a regular aerosol bronchodilator and continue to experience a bronchospasm (airway constriction). It works by relaxing and opening the airways to the lungs, making breathing easier.
How does albuterol-ipratropium for COPD work?
Both albuterol and ipratropium are bronchodilators, but from two different classes: ipratropium is an anticholinergic agent that blocks an increase of calcium ions in muscle cells of the lungs, relaxing the airways. Albuterol is a beta2-sympathomimetic, meaning that it is a selective beta2-adrenergic receptor agonist. These receptors are present on the smooth muscle of the bronchi and, when stimulated, they relax the muscle and open the airways. Albuterol also increases the flow of calcium and potassium ions through the walls of the bronchi muscle cells, causing an imbalance of charges (membrane hyperpolerization) that leads to muscle relaxation.2,3
Studies of albuterol-ipratropium
The effectiveness of albuterol-ipratropium inhalation spray (20 mcg/100 mcg; Combivent Respimat) was compared with ipratropium inhalation spray (20 mcg) alone, and a previous albuterol-ipratropium formulation (CFC-propelled; 36 mcg/206 mcg) in more than 1,420 people with COPD in a Phase 3 clinical trial  (NCT00400153). During the 12-week study, participants were tested for different FEV1 measures at different times before and after treatment. Combivent Respimat was found to be as effective as the earlier Combivent formulation, and superior to ipratropium alone. No efficacy differences were seen among patients according to sex or age. The median time for the start of bronchodilation (increase of 15% or greater in FEV1) in treated patients was 13 minutes post-treatment.
A later study in 1,118 COPD patients evaluated the safety of a higher-that-approved dose of albuterol-ipratropium inhalation spray (40/200 mcg) with positive results.
Indications and side effects
Combivent Respimat is an inhalation spray in using an inhaler device, and is usually inhaled four times a day. Dizziness and blurred vision may occur with this medication.
The most common side effects reported include ear, nose, and throat infections; runny nose; cough; bronchitis; headache; and shortness of breath.
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