6 Common Nebulizer Medicines
Last updated: April 2023
So, your doctor wants you to take breathing treatments. Or, perhaps you take breathing treatments already. Here are the 6 most common nebulized medicines used for COPD.
Normal saline (sodium chloride)
It's a solution that contains a 0.9% mixture of sodium chloride, or salt. The salt is needed to match the salt content of your body. Another name for it is saltwater. It's just saltwater. It's not prescribed on its own. But, about 0.3cc of normal saline is premixed with solutions of respiratory medicine to make breathing treatments last long enough to be effective. The solutions are stored in plastic amps. These amps have easy to remove twist-tops.
So, that said, here are your respiratory medicines.
Respiratory medicines used for COPD treatment
It’s a bronchodilator. It's referred to as a beta-adrenergic medicine because the medicine binds to beta-adrenergic receptors lining airways. It relaxes smooth muscles that are wrapped around airways. In this way, it opens airways to allow air to flow easily through them. It starts working in a matter of seconds. So, it's often called "rescue medicine."
It lasts for 4-6 hours. Some physicians prescribe it to be used as needed when you feel short of breath. However, some physicians prescribe it to be inhaled four times daily to prevent symptoms. For COPD, it is often combined with ipratropium bromide.
Side effects are generally considered negligible. The most common side effect is tremors.
Ipratropium Bromide (Atrovent)
It’s a different type of bronchodilator. It's referred to as a muscarinic because the medicine binds with muscarinic receptors lining airways. Like albuterol, it relaxes the muscles that wrap around airways. This causes airways to open, thereby making breathing easier.
The medicine lasts 4-6 hours. So, it's usually prescribed QID, or four times a day. It's sometimes prescribed by itself. But, more often than not, it's given with albuterol. This is done to keep your airways open long term and prevent symptoms.
As noted, COPDers are often prescribed both Ventolin and Atrovent together. Because both are pre-mixed with normal saline, breathing treatments can last a long time. So, Duoneb is a mixture of Ventolin, Ipratropium Bromide, and 0.3cc of normal saline. This makes it so you can inhale both medicines at the same time with only one dose of saline. It makes for a nice, quick treatment.
Like albuterol, it’s a bronchodilator and beta-adrenergic. It's also a rescue medicine. Initial studies showed it was stronger and safer than albuterol. However, subsequent studies have not confirmed the initial expectations. In fact, a 2009 study showed there was no difference between albuterol and levalbuterol as far as efficacy.1 A 2011 study showed there was no difference as far as side effects.2 Still, it's an alternative to albuterol that some doctors and COPDers find helpful.
It’s an inhaled steroid. It's the only inhaled steroid available as a solution. Some people with COPD have a hard time generating enough flow to actuate inhalers. For this reason, Pulmicort is a nice option for some people with COPD. The medicine lasts 12 hours, so the recommended dose is one treatment twice daily.
Brovana (arformoterol tartrate)
It’s a long-acting bronchodilator. It's also referred to as a long-acting beta-adrenergic (LABA). It lasts for up to 12 hours. This makes it so you only need to use it two times a day. The goal is to help you obtain good COPD control. Most people using Brovana also have a PRN (as needed) prescription for albuterol. However, the goal is to not need your albuterol. Still, if you need to, it is considered safe to use albuterol in between Brovana breathing treatments.
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