Compatible Stability and Aerosol Characteristics of Atrovent® (Ipratropium Bromide) Mixed with Salbutamol Sulfate, Terbutaline Sulfate, Budesonide, and Acetylcysteine

Abstract

(1) Background: It is common practice in the treatment of respiratory diseases to mix different inhalation solutions for simultaneous inhalation. At present, a small number of studies have been published that evaluate the physicochemical compatibility and aerosol characteristics of different inhalation medications. However, none of them studied Atrovent®. Our work aims to address the lack of studies on Atrovent®. (2) Methods: Portions of admixtures were withdrawn at certain time intervals after mixing and were tested by pH determination, osmolarity measurement, and high-performance liquid chromatography (HPLC) assay of each active ingredient as measures of physicochemical compatibility. The geometrical and aerosol particle size distribution, active drug delivery rate, and total active drug delivered were measured to characterize aerosol behaviors. (3) Results: During the testing time, no significant variation was found in the pH value, the osmotic pressure, or the active components of admixtures. With the increase in nebulization volume after mixing, fine particle dose (FPD) and total active drug delivered showed statistically significant improvements, while the active drug delivery rate decreased compared to the single-drug preparations. (4) Conclusions: These results endorse the physicochemical compatibility of Atrovent® over 1 h when mixed with other inhalation medications. Considering aerosol characteristics, simultaneous inhalation is more efficient.

Individualized airway atomization improves preoperative lung dysfunction in patients with chronic rhinosinusitis with nasal polyps

“…Triple inhaled therapy has been considered to be effective for treating chronic obstructive pulmonary disease and reducing the risk of an acute asthma attack because of its synergistic effect in reducing airway inflammation and mucosal edema, with strong dilation of the bronchi. 5,6 Therefore, we have introduced an innovative atomization strategy into our preoperative airway management procedure by providing atomization treatment at different frequencies based on the severity of each patient's obstructive ventilation dysfunc-tion. Our results prove that individualized atomization intervention is a rapid and effective way of improving pulmonary dysfunction of differing severity.…”

A Case Study of an Adverse Reaction to Inhaled Terbutaline-Causing Tremor in Both Hands

“…The patient's lung function: severe mixed pulmonary ventilation dysfunction, and the doctor has given him budesofrine inhalation aerosol, which contains the β2 agonist formoterol, and if it is intolerable, the literature suggests that AZD3101 can be used [17]. The literature suggests the use of AZD3199 (inhaled ultra-long-acting β₂-adrenoceptor agonist), which has a higher safety profile than formoterol, with a very low incidence of adverse effects that may be related to its lower level of systemic side effects, as well as in combination with fluticasone propionate inhalation aerosol and tiotropium bromide powdered inhalation or with other glucocorticosteroid inhalers and M-receptor blocking agents [18]. Glucocorticoid inhalers inhibit the release of inflammatory mediators from the airway, suppressing the body's inflammatory response and improving airway function, and M receptor blockers reversibly inhibit M cholinergic receptors, causing smooth muscle relaxation [19,20].…”