Combivent (salbuterol, iprotropium bromide) is an orally-inhaled bronchodilator, used in long-term treatment of bronchospasm in conditions such as chronic obstructive pulmonary disease (COPD).

The medication works by relaxing and dilating the bronchi in the lungs while minimizing mucus secretion, making it easier to breathe. Combivent provides a number of benefits:

• Improves breathing
• Reduces frequency and severity of flare-ups
• Can be used with other medications
• Convenient and easy to use

Combivent is intended for long-term management. It is not intended to replace the use of a rescue inhaler such as epinephrine or albuterol in an emergency situation.

Breathing Easier with Combivent

Combivent is an inhaler that delivers the medication directly to the lungs, which provides more rapid results than other administration methods and reduces risk of side effects compared to administration by injection or tablet.

The inhaler contains two active ingredients:

• Salbuterol, better known as albuterol; and
• Ipratropium bromide.

Both ingredients 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, though, as well as in combinations.

Following standard guidelines for use, administration is simple:

• Inhalers should be primed before first use or if it hasn't been used for several days; simply spray it three times into the air.
• Shake inhaler vigorously for ten seconds prior to use.
• Standard treatment is 2 inhalations 4 times a day, at evenly-spaced intervals.
• Additional inhalations may be administered as-needed throughout the day, provided 12 inhalations in 24 hours is not exceeded.

Used regularly Combivent should reduce the frequency of COPD flare-ups, and likely reduce the severity of them when they do occur. It will take several weeks of regular use for significant benefits to be noticeable. Treatment may continue for as long as it provides benefit.

Combivent & Asthma

In some places Combivent is not approved by regulatory agencies for use in asthma or use as a rescue inhaler in any condition, but in real-world practice it is commonly used for both. As is the case with any asthma treatment, it works well for some, but doesn't work well for others. In rare cases it can worsen asthma.

Some patients find reduced frequency of asthma attacks if Combivent is used in the standard 2 inhalations 4 times a day guidelines for COPD. Others notice no difference. This seems to be simply individual response; effects are similar with inhaled steroids---it works for some but not others, for reasons not fully understood.

A concern often cited in using Combivent for asthma, particularly as a rescue inhaler, is paradoxical bronchospasm, in which the medication causes airways to close rather than open. This can occur even if the medication has been used without issue for a long time, though it is by far more commonly experienced with the first use of a medication.

Ironically it is salbuterol (albuterol) that poses the paradoxical bronchospasm risk in Combivent; albuterol is one of the most widely-used asthma treatments in the world, and it's a rare asthmatic who hasn't had experience with it. This risk is present with albuterol-only inhalers as well as some other, non-albuterol inhalers. Paradoxical bronchospasm is rare, but it does happen and it can be life threatening.

The final significant concern with Combivent in asthma is simply the speed with which it works; it can take up to 30 minutes to provide significant relief, though it may work much quicker, too; response to treatment depends on a number of variables. If a faster-acting rescue treatment is unavailable a slow-acting treatment is preferable to none; however, it may be wise to keep a faster-acting alternative on hand.

We are not trying to persuade or dissuade patients from using Combivent for asthma or other off-label purposes; the above is simply an explanation to why patients often find conflicting information about this product.

Other Considerations

Combivent inhalers should be cleaned on a weekly basis following instructions on the package insert. Keep the cap over the mouthpiece when not in use to prevent dust, microbes and other unpleasantries from coating the mouthpiece.

As it will take a few weeks for significant long-term results to be seen, use should not be discontinued even if it doesn't appear to be having the intended effect. On the other hand, if the condition worsens, use should discontinue until a doctor can be consulted.

Do not spray the inhaler near open flame.

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.

When the dose indicator has counted down to empty the inhaler should be replaced; metered doses can no longer be counted on.