Combimist L (salbuterol, iprotropium bromide) is a metered-dose maintenance inhaler for use in patients with chronic obstructive pulmonary disease (COPD) or asthma. Combimist L is not meant to replace a rescue inhaler for active attacks; rescue inhalers should be kept on-hand for use if needed. In practice, however, many patients do use Combimist L as a rescue inhaler.

Patients who use Combimist L as a maintenance inhaler should be able to breathe easier, reducing the frequency and severity of COPD or asthma attacks. Dependency on rescue inhaler use should be reduced. It takes a few weeks of regular use for these effects to be noticeable.

Combimist L can be used in all ages, though a doctor should determine dosage and administration frequency for children.

Combimist L Basics

This product contains two active ingredients to help patients breath easier:

• Salbuterol, better known as albuterol, is a short-acting beta agonist that relaxes and widens airways. This medication is very common in rescue inhalers.
• Ipratropium bromide also helps relax and widen airways, but perhaps more significantly it reduces mucus production and thins existing mucus for easy expulsion.

Both ingredients in Combimist L are bronchodilators, which open airways by relaxing bronchial muscles, though they do so in different ways which provides a greater effect than either medication used independently. They are both used independently, however, salbuterol/albuterol as a rescue inhaler and iprotropium bromide to treat COPD and asthma as well as colds, runny noses, and so forth. Combimist L combines them both for ease of use.

While not recommended as a rescue inhaler, in practice some patients use Combimist L as such, and for some individuals it works quite well. Others find results mediocre at best, largely due to Combimist L's slower time to start working (it can take up to 30 minutes for maximum results). It likely depends on individual response to treatment as well as the severity of the asthma or COPD being treated.

Whatever Combimist L is being used for---maintenance or rescue---treatment should not exceed 12 inhalations per 24 hours.

Dosage & Administration

Combimist L should be primed prior to first use or if unused for several consecutive days. Priming is accomplished by spraying the inhaler into the air three times; it is now ready for use.

Used as a maintenance inhaler:

• Shake inhaler vigorously for ten seconds prior to use.
• Standard treatment is 2 inhalations 4 times a day, at evenly-spaced intervals.

As a rescue inhaler:

• Shake inhaler vigorously for ten seconds prior to use.
• Administer 2 inhalations as-needed throughout the day, up to a maximum of 12 inhalations in 24 hours.
• If Combimist L is not providing significant benefit a designated rescue inhaler should be tried or, if unavailable, medical attention should be sought.

It takes two to four weeks of regular use for long-term benefits to be noticeable. Many patients have good results using Combimist L as a maintenance inhaler, experiencing fewer attacks and less severe attacks when they do happen. Treatment can continue for as long as the medication provides benefit, which is often indefinitely.

Precautions

As it will take a few weeks for significant long-term results to be seen, use should continue for several weeks even if it doesn't appear to be having the intended effect.

Paradoxical bronchospasm is a concern with salbutamol/albuterol use; though rare, this can cause breathing to quickly become difficult. If this occurs do not use Combimist L or any medication containing salbutamol/albuterol until a doctor can be consulted. Paradoxical bronchospasm can occur even if the medication has been used without issue for a long time, though it is more commonly experienced with the first few uses.

Do not spray the inhaler near open flame; it may ignite.

Do not puncture the inhaler or store it in a hot location, such as a vehicle on a hot day; overheating or puncturing can cause the inhaler to explode.