DuoNeb

[becksdad]

We have Duoneb that we usually use after albuterol alone, or with a patient who has obtained no little or no relief with MDI or a home nebulizer. It often (but not always) makes a big difference. We also use Solumedrol that helps a lot, but later rather than sooner.

[kevkei]

Because there are very few reasons why you would want ipratropium (Atrovent) by itself, purchase it in the Combivent/Duovent form. We use it in pre-mix of 2.5 mg albuterol (salbutamol/Ventolin) with 500 mcg of Atrovent but add 2.5 mg of albuterol for a 5 mg/500 mcg dose.

Atrovent only really works well in reactive airway disease (asthma) and doesn't do much for chronic bronchitis and/or emphysema (the COPD pts). It works well in the younger patient with isolated bronchospasm from asthma and doesn't generally do much for the COPDer's.

Why? The reasons have been indicated, it is synergistic in it's effects when combined with Albuterol but also works by a different mechanism. As it is an anticholinergic, obviously it works by a different mechanism, essentially it is working through the back door. As opposed to trying to stimulate Beta II receptors to cause bronchodilation it blocks the cholinergic effects that cause, as well as the secretions (the asthma triad - 3 S's - spasm, swelling, secretion). It's onset of action is slower than albuterol and is delayed but it has a longer duration of action. Similar to a corticosteroid, it can help reduce a rebound effect.

[1EMT-P]

Kevkei, Ipratropium Bromide is not indicated in the treatment of acute bronchospams, it is however indicated in the treatment of COPD, Chronic Bronchitis & Emphysema. Studies have shown that patient's with bronchospasms related to COPD, Chronic Bronchitis & Emphysema have shown significant improvement in pulmonary function following the administration of Ipratropium Bromide.

[OzMedic]

Kevkei, Ipratropium Bromide is not indicated in the treatment of acute bronchospams.

This is fairly limited thinking! Try treating acute bronchospasm with albuterol on a patient on non-selective betablockers and see how far you get.

[1EMT-P]

OzMedic, This thread is not about bronchospams in patient's on beta blockers... It is about the use of DuoNeb in the field...

... If you would like to discuss the issue of bronchospasms in patient's on beta blockers please start a new post!

[kevkei]

Kevkei, Ipratropium Bromide is not indicated in the treatment of acute bronchospams, it is however indicated in the treatment of COPD, Chronic Bronchitis & Emphysema. Studies have shown that patient's with bronchospasms related to COPD, Chronic Bronchitis & Emphysema have shown significant improvement in pulmonary function following the administration of Ipratropium Bromide.

Wow, you had me royally peeved there for a minute until I went back and re-read my post. I do apologize as I had it bass ackwards :? I guess that's what I get for not reading it before hitting the submit button, not that it would have helped :oops: .

And it is indeed indicated in acute bronchospasm.

[OzMedic]

OzMedic, This thread is not about bronchospams in patient's on beta blockers... It is about the use of DuoNeb in the field...

... If you would like to discuss the issue of bronchospasms in patient's on beta blockers please start a new post!

lol, ouch! I was just trying to point out that we need to keep and open mind before applying hard and fast rules to when and why we administer drugs. Sorry If I was to abrupt but my original point still stands.

[1EMT-P]

I have treated several patients who have had asthma & been on beta blockers. If the patient does not respond to oxygen therapy & nebulized Albuterol then I add Ipratropium bromide, if they still do not respond then I usually move on to

Epinephrine 1:1,000 0.3mg IM/SC & Fluids.

FYI: There are quite a few relative contraindications to beta blockers, including Asthma, Bradycardia with a heart rate less than 60 beats per minute, CHF, COPD, emphysema, hypotension 2nd or 3rd degree heart block & immunotherapy just to name a few.

[OzMedic]

I have treated several patients who have had asthma & been on beta blockers. If the patient does not respond to oxygen therapy & nebulized Albuterol then I add Ipratropium bromide, if they still do not respond then I usually move on to

Epinephrine 1:1,000 0.3mg IM/SC & Fluids.

FYI: There are quite a few relative contraindications to beta blockers, including Asthma, Bradycardia with a heart rate less than 60 beats per minute, CHF, COPD, emphysema, hypotension 2nd or 3rd degree heart block & immunotherapy just to name a few.

Are you serious or just trying to have a laugh? Oh, I get it...........ok guys where's the camera?

[kevkei]

How about Mag Sulfate? As well, fluids in asthma has been proven through studies to have no value and doesn't improve patient outcomes.