Ipratropium Bromide

How it works

Competitively blocks muscarinic acetylcholine receptors in bronchial smooth muscle, reducing cholinergically mediated bronchoconstriction and mucus secretion to produce bronchodilation.

Prescribing in practice

• It is an add-on bronchodilator in acute severe asthma alongside a short-acting beta-2 agonist and steroid, not a first-line or sole reliever.
• Use a mouthpiece or well-fitting mask and avoid contact with the eyes, as nebulised antimuscarinic can precipitate or worsen acute angle-closure glaucoma and cause blurred vision.
• Confirm age-appropriate delivery and dosing against a children's formulary and acute asthma guidance.

Monitoring

Monitor respiratory status and treatment response during acute episodes; routine long-term monitoring is not generally required.

Counselling the patient

• Explain this is given with reliever therapy during a bad asthma attack, not for everyday use.
• Keep the nebuliser mist out of the eyes and use a mouthpiece where possible.
• Report any eye pain, visual disturbance or worsening breathing.

Evidence & guidelines

Nebulised ipratropium as an adjunct in acute severe paediatric asthma is supported by BTS-SIGN/NICE acute asthma guidance.