What is the difference between Albuterol and Ipratropium bromide?

Both Albuterol and Ipratropium bromide are common medicines that help you breathe when you have chronic obstructive pulmonary disease (COPD).

Many of the symptoms of COPD–like wheezing, chest tightness, coughing, and shortness of breath–are caused by tightening of the smooth muscles inside your airways, known as your bronchial tubes. This is called a bronchospasm. In many people, bronchospasm causes the size of the airways to shrink from the size of a dime to the size of a pencil or, in severe cases, as small as a straw or coffee stirrer.

Because of the way they work, both Albuterol and Ipratropium bromide are known as bronchodilators. That means they help relax and open–or dilate–the smooth muscles in the bronchial tubes, which makes it easier for air to pass in and out of the lungs.

How are Albuterol and Ipratropium bromide used?

Both Albuterol and Ipratropium are most often delivered directly into the airways through inhalers and nebulizers. Inhalers are special devices that deliver measured puffs of tiny droplets of medicine that you inhale deeply. Nebulizers convert liquid medicine into a mist that you breathe in through a mask or mouthpiece for a 10-15 minute time period. The key is that both types of medication are delivered directly to your airways, where they are needed most.

Fast relief

Both Albuterol and Ipratropium bromide are fast-acting and provide immediate relief from severe symptoms and breathing problems. Ipratropium bromide is an anticholinergic medication and albuterol is a short-acting beta₂-adrenergic agonist. Although they act quickly, within minutes, the relief doesn’t last very long, generally around 2-4 hours.¹ For this reason, they are known as “rescue” or “reliever” medications, as opposed to maintenance medications, which are used to limit COPD symptoms over the longer term.

Different action in the body

The main difference between Albuterol and Ipratropium bromide concerns the way they act inside the body and how, in precise biochemical terms, they cause the airways to relax or open. The two medications also have different side effects. Because of this, the two agents are often used together as a combination therapy.

Albuterol

Albuterol is known as a ß2-agonist. It stimulates specific nerve receptors in the body–called ß2 adrenergic receptors–that release epinephrine, one of our body’s fight or flight hormones.⁴ This triggers an immediate response throughout the entire body, causing our heart rate to increase, our air passages to expand, and our pupils to dilate. We also experience increased blood flow to the muscles. Albuterol acts within 5 minutes when delivered by an inhaler or nebulizer.

Ipratropium bromide

Ipratropium bromide acts differently. It belongs to a class of drugs known as anticholinergic agents. These block the action of a natural chemical in the body called acetylcholine. In the lungs, acetylcholine acts to restrict airways and increase mucus production. By blocking acetylcholine, Ipratropium bromide makes it easier to breathe. Ipratropium bromide takes about 15-30 minutes to work, and it lasts about 4-5 hours.⁷

Different side effects

Because Albuterol stimulates our fight or flight response, other muscles and systems in the body are affected as well. This is what is behind many of its common–and sometimes unpleasant–side effects. These include irregular heartbeat or palpitations, shaking, nervousness, headache, nausea, and vomiting. Ipratropium bromide causes fewer side effects. These include dizziness, nausea, heartburn, constipation, dry mouth, urgency or pain when urinating, and back pain.⁹