Ipratropium Bromide Metered Dose Inhaler: Severe Asthma Attack Dosing

Therapeutic action

Bronchodilator, anticholinergic drug.

Indications

Severe asthma attack, in combination with salbutamol.

Forms and strengths

Solution for inhalation in pressurised metered dose inhaler, delivering 20 micrograms of ipratropium per puff.

Dosage and duration

Child and adult: 4 to 8 puffs (80 to 160 micrograms) every 20 minutes for the first hour.

Administration technique

• Shake the inhaler and remove the mouthpiece cover.
• Inhale and breathe out as completely as possible, then place the lips tightly around the mouthpiece.
• Inhale deeply while activating the inhaler, then hold breath for 10 seconds before exhaling.
• Hand-breath coordination is very difficult in children under 6 years, older patients, and patients with severe dyspnoea. Use a spacer to facilitate administration and improve treatment efficacy.

Contra-indications, adverse effects, precautions

• May cause throat irritation, headache, cough, vomiting, dryness of the mouth, constipation, dilation of the pupils, blurred vision, urinary retention, and tachycardia.
• Administer with caution to older patients and patients with closed-angle glaucoma, urethroprostatic disorders, or urinary retention.
• Avoid or monitor combination with drugs known to have anticholinergic effects, including tricyclic antidepressants, first-generation H1 antihistamines, biperiden, antispasmodics, and antipsychotics.
• Pregnancy and breast-feeding: no contra-indication.
• In severe asthma attack, preferably administer treatment by nebulisation.
• Clean the mouthpiece before and after each use.
• Do not pierce or incinerate used aerosol containers because of explosion risk.