Subjects were randomized to receive either ipratropium
bromide or normal saline, matched to the albuterol dosing interval.
Drug Cost/Day* Dosage [beta]-AGONISTS SHORT ACTING albuterol inhalation $0.08 per 2 inhalations every 4 hours aerosol actuation or as needed albuterol HFA [$0.18 per 2 inhalations every 4 hours inhalation aerosol actuation] or as needed [Ventolin HFA] LONG ACTING salmeterol inhalation no generic 1 inhalation (50 mcg) powder available every 12 hours [Serevent Diskus] [$3.09] formoterol fumarate no generic 1 inhalation (12 mcg) inhalation powder available every 12 hours [Foradil Aerolizer] [$2.66] ANTICHOLINERGICS SHORT ACTING ipratropium
bromide no generic 2 inhalations q.i.d.
Nor was the combination of ipratropium
and albuterol particularly more effective at increasing forced expiratory volume in 1 second ([FEV.sub.1]) than albuterol alone.
Clinical question Does the addition of ipratropium
bromide to [Beta]-agonist therapy improve outcomes in adults with acute asthma exacerbations?
In response to concerns about chlorofluorocarbons (CFCs) depleting the ozone layer, the new formulation of ipratropium
bromide (Atrovent HFA Inhalation Aerosol, Boehringer Ingelheim Pharmaceuticals Inc.) contains the propellant hydrofluoroalkane (HFA) instead.
bromide is considered to be first-line therapy in chronic obstructive pulmonary disease, but salmeterol xinafoate is the better choice because it is longer acting, reported Dr.
Effect of continuously nebulized ipratropium
bromide plus albuterol on emergency department length of stay and hospital admission rates in patients with acute bronchospasm.
Clinical question Does ipratropium
, when added to beta-agonists and oral corticosteroids, decrease the rate of hospital admission among children with acute asthma attacks?
(See table.) Levalbuterol patients required ipratropium
bromide and nebulizer therapy on significantly fewer days than did racemic albuterol patients, thus contributing to lower medication costs.
Therapeutic Agents Available in Metered Dose Inhaler Duration Average Peak of Cost per Pregnancy Effect(*) Effect(*) Inhaler(**) Category Drug (minutes) (hours) ($) (FDA) [beta]-Adrenergic Isoproterenol 5-15 1-2 23.63 C Isoetharine 15-60 2-3 26.98 C Metaproterenol 30-60 3-4 20.23 C Terbutaline 60 4 22.10 B Albuterol 30-60 4 24.16 C Bitolterol 30-60 5 18.00 C Pirbuterol 30-60 5 18.82 C Anticholinergic Ipratropium
60-120 3-6 26.80 B Biscromones Cromolyn 15-30 2-6 37.15 B (*)Data from Physicians' Desk Reference, Drug Evaluations, and Bar-Yish ay et al. (**) Derived from pharmacy price quotes.