Atrovent inhaler (ipratropium bromide) is an anticholinergic bronchodilator used in the ongoing treatment of bronchospasm in conditions such as emphysema, bronchitis, asthma, and chronic obstructive pulmonary disease (COPD).

The medication works by relaxing and dilating airways in the lungs. It also minimizes mucus secretion, making it easier to breathe. It is typically prescribed as a long-term treatment, used daily regardless of symptoms. In this application it may reduce the frequency and severity of exacerbations.

Atrovent inhalers are also sometimes used as rescue inhalers, to quickly alleviate shortness of breath and wheezing, but some patients find they don't work as quickly as more widely-used rescue inhalers, such as albuterol. The reason some patients find it effective as a rescue inhaler while others do not are unclear; it may be worth a try to see if it works for a given individual, but a proven rescue inhaler should be kept on-hand until effects are clear.

In both applications Atrovent inhalers provide a number of benefits:

• Alleviates impaired breathing due to bronchospasm
• Convenient, easy-to-use inhaler
• Metered dosing makes it easy to know when to refill
• Provides long-term benefit
• Can be used in conjunction with other therapies for greater control

Atrovent inhaler's active ingredient, ipratropium bromide, is also sometimes combined with other bronchodilators in a single inhaler, such as Combivent. These combination products are typically used for long-term management when a single product is insufficient, though there are exceptions.

Getting the Most from Atrovent Inhalers

As mentioned above, Atrovent inhalers are intended for long-term management and use as a rescue inhaler is not approved in many parts of the world. However, it is often prescribed as such in off-label use; off-label use is fully legal, it will just be difficult to find authoritative information about use in off-label applications as regulatory agencies have not approved it for those applications.

To reduce the frequency and severity of bronchospasm exacerbations the medication needs to be used regularly long-term:

• Administer 2 inhalations 4 times per day, at evenly-spaced intervals.
• Continue daily treatment even if no symptoms are present.

As a rescue inhaler:

• Administer 1 or 2 inhalations as needed.
• Do not exceed 12 inhalations in a 24 hour period.

Before first use, or if the Atrovent inhaler has not been used for three or more days, the inhaler will need to be primed. To prime it, simply spray it twice into the air. The inhaler should cleaned on a weekly basis as well. More detailed instructions on priming and cleaning can be found on the insert included with each product.

Atrovent inhalers are metered; a full inhaler will display a green dose indicator. When fewer than 40 doses remain this indicator will turn red. This is a convenient reminder to refill the prescription to ensure an adequate supply is always on-hand. The inhaler may appear to continue working after the meter is down to zero, but it may not be delivering full a dose of medication.

Possible Side Effects

Very rarely some individuals have an allergic reaction to Atrovent inhalers, which warrants emergency medical attention. Symptoms include difficulty breathing, swelling of the face or throat, hives on the skin, and very rapid or erratic heartbeat. These symptoms usually develop very quickly after first use.

Common side effects associated with Atrovent inhalers are typically mild and not cause for concern unless severe enough to be disruptive. If using the inhaler daily for long-term management, side effects will often stop occurring altogether as the body adjusts to treatment. Most commonly experienced are:

• Headache
• Mild dizziness
• Mild nausea
• Tremor
• Dry mouth, dry cough
• Mild throat irritation
• Mild flu-like symptoms

Other side effects are possible; consult a doctor or pharmacist with any concerns.

Because the medication in Atrovent inhalers is delivered directly to the lungs, relatively little is absorbed into the bloodstream. However, enough is present that it can cause potential complications when mixed with other medications. Discuss risks with a doctor if also taking:

• Urinary or bladder medications
• Antihistamines, found in cold or allergy medications
• Other bronchodilators
• Parkinson's disease medications
• Medications intended to treat irritable bowel syndrome, vertigo, gastric ulcer, or heartburn

Not all potential drug interactions are negative; taking Atrovent inhalers in combination with beta-adrenergic agonists increases the overall efficacy.