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Can anyone help? Should you use atrovent neb and spiriva

Hi i havent posted on hear before, but depseratly need some advice. I have had a bad cold which seemed to really aggrevate my asthma over the weekend ( as it does). I started pred and saw nurse on monday as plan, went back monday afternoon as no better, she gave me neb there and then and sent me home with nebulizer and ventolin nebs, had most horrendous last night, constant coughing, so went back this morning and got send to hospital, was in there an hour and sent home with atrovent and salbutamol nebs and some antibiotics an increased pred, went back to gp this afternoon as still not better, she says continue with nebs etc and call ambulance if no better tonight. Now i have got all that of my chest question to you is should you take atrovent nebs and spiriva inhaler, i have heard that you shouldnt can anyone help me?

I am sorry for the big rant!!!

5 Replies

Hi Sarah

Welcome to the boards. I'm on Spiriva too but when I need regular atrovent nebs I don't take it. I'm sure someone with more knowledge than me will be along shortly to explain the technical reasons why but as far as I'm aware it is a similar drug - Spiriva is just a longer acting version. I've been given Atrovent nebs in A&E despite having had Spriva that day but then just stick to Atrovent for a couple of days.





yeah when im on regular artovent nebs i stop my spiriva. it is the same thing. the spririva is a long acting version of atrovent. the spiriva is a 24hour lasting thing and the atroent is six hours i think.

someone wiht more medical knowledge will ahve a better idea.



Hi there Sarah,

Welcome to Asthma UK. I'm sorry to hear you've been having a rough time recently, and please don't apologise for ranting! We are usually a friendly bunch and I hope you will find that we are a useful source of support.

Firstly, something we say to all new members - please remember as you browse the boards that sites like this one invariably attract people at the more severe end of the spectrum in disproportionate numbers. You may well read accounts of poor control, multiple medications, frequent hospital admissions and even Intensive Care admissions. Experiences like this, whilst unfortunately common on this board, are not typical of asthma in general. The vast majority of people with asthma can be well controlled with the right combination of medication. Asthma UK is for everyone who is affected by asthma, and we wouldn't want anyone to be put off by reading about some of the more extreme experiences that some of our members have been through.

Secondly, I'm a little concerned about you and your asthma treatment. Is this the first time you have been given a home nebuliser, and do you have strict guidelines for its use? The decision to give someone a home nebuliser is not one that is made lightly, and will usually be reached by a hospital respiratory consultant in conjunction with the patient, the GP and other healthcare professionals such as respiratory nurses. It is powerful medication and it can be dangerous if used incorrectly.

There is a very real danger that someone who has a neb at home will have a false sense of security about how easily their asthma can be treated, and will keep nebbing when they really should be getting into hospital and having other treatment. In a severe attack, nebs will often not work alone, and other treatments like IV hydrocortisone, IV magnesium and IV aminophylline may be needed, or even, in an extreme case, intubation and mechanical ventilation. By the time someone gets to the stage where nebs aren't working, they are usually extremely unwell and need to be in hospital very quickly. The large majority of asthmatics, if they are ill enough to need nebs, should be in hospital where they can be closely monitored. Those of us at the severe end of the spectrum who do have home nebs have very strict guidelines for their use, and clearly defined thresholds for when to go into hospital if the nebs aren't working.

It sounds like you did exactly the right thing today going back to your doctor and then in to hospital. I hope you will find that things improve as the pred begins to kick in, but please do have a very low threshold for calling an ambulance and going back to hospital if you have another bad night. As I am sure you know, asthma can be very dangerous - a severe attack can be fatal - so it really is not worth taking any chances.

I wonder if I can ask who manages your asthma? Looking at your profile, you are on quite a lot of medication. Are you managed by a hospital respiratory consultant? Certainly, if home nebs are being suggested, a referral to a respiratory specialist would seem to be appropriate. If you are already under a respiratory specialist, it may be worth trying to get an appointment with them soon to discuss the issue of home nebs.

To answer your question about ipratropium (Atrovent) and tiotropium (Spiriva), they are very similar drugs. As already mentioned, tiotropium is a longer acting (and more selective) version of ipratropium. They shouldn't really be used together - doing so would put you at increased risk of side effects from them. There is no clear evidence to say whether it is better to continue to take Spiriva or to switch to ipratropium nebs for a few days during an exacerbation. I am on Spiriva, and when I am admitted, it seems to vary each time as to whether they switch me and how long they leave me on ipratropium! If your GP has prescribed ipratropium for you then using it for a few days instead of the Spiriva is probably the way to go; if in doubt, do check it out with your GP though.

Hope this helps, and that you feel better very soon

Take care

Em H

(forum moderator)


Hi Sarah, Each time I`m admitted to hospital and have to tell them I can`t have Salbutamol nebs(cause dreadful side effects- hallucinations, resless body etc) I`m given Atrovent Nebs and again I have to tell them that I musn`t use my Spiriva. I dread being so ill that I can`t give this info `cos believe me the horrific night I endured after being put on Sal nebs I`ll never forget. Think I`ll get one of those dog collars you can put a roll of paper in with all the info!




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