Asthma UK community forum


Sorry if this has been answered before but I had a look and couldn't quite find what I was after in the other Atrovent posts.

Just been prescribed this by GP, it tastes awful but seems (just on a couple of puffs) to be doing at least something! Label says 'two puffs when symptoms' and I know it works differently from salbutamol. However, I'm still a bit confused about when I would take this instead of Ventolin - do you alternate, or what? eg if I woke up in the night would I reach for this or for Ventolin?

And are you supposed to limit how much you take? The label has all the usual stuff about don't take too much, if you miss a dose skip it etc etc which I know doesn't really apply to Ventolin, but I don't want to take too much Atrovent.

Basically I don't really know where I am this one so any pointers would be appreciated - thanks!

31 Replies


Im not sure but my daughter takes hers along side the salbut she is precribed 2 puffs 3 x a day. We dont ever go over that ( well unless my dh doesnt listen and he gave her her salbut dose which at th emo is 10 puffs )....



Thanks Natasha! I think it would be easier if I had a set dose like your daughter, it's the 'with symptoms' that gets me as I have them rather a lot right now and am not sure how Atrovent fits in with everything else.

I hope it helps your daughter?



Im not sure if it works the same as the nebules, but when im on atrovent nebules im not allowed anymore than four in a day and it is to be taken in conjunction with the salbutamol as it doesnt work as effectivly!?

sorry its not much help!




ive been told that you have to leave 4-6 hours between atrovent doses as otherwise it has no effect. so usually people get told to take it 4 times a day rather than on an as and when needed like salbutamol.

hope this helps!

B x


please correct me if im wrong, but i think there is more of a risk in taking too much atrovent as opposed to ventolin, as it can make your heart race and/or give you the shakes, and this is more common than with ventoline. what b said sounds about right to me concerning the dose per day. i hope it helps and you get some relief soon!

Rose xxx


Atrovent works in a different way than sally, it can be taken the same time but dont take more than the 2 puffs at once and can be repeated after 4 hours.

Its called a antimuscuratic broncodilator and works by stopping the spasming its similar to spirivia that you might of heard of



It is foul stuff ?as it's got ethanol in the base too, the propellant HFA 134a is the same as ventolin.

I have also found dosing to be rather vague as the first few labels said use as directed but they didn't tell me what. It can be taken 'one or two puffs to be inhaled three or four times daily • Sometimes, in early treatment, up to four puffs at a time may be taken' according the leaflet. My practice seem to say either 1 puff 4 times or 2 3 times a day for a starting dose but can use it up to 2 4 times a day to get back under more control.

Personally I haven't had prednisolone since starting it. Practice nurse has been more helpful than GP & cons. overall by pointing this out i.e. I seem better on bronchodilators than steroids so it may help if I can get the cons. to agree that I can try theophylline in the future if needed.

Edit to add

P.S. Bizkid how are you doing these days?


wow! I cant believe others are on atrovent, every time I have to tell a doctor {other than the one who prescribed} they are like, ""theres little evidence that atrovent helps with asthma"" and I feel like I have to defend it, not because its some great wonder drug but it does help, I find Im not so frothy since using it, btw Im prescribed 2 puffs 3 times a day hope thats of some use xxx


Thanks everyone! All this is really helpful, I think I'm going to stick to every 4 hours or so. Think it's doing a reasonably good job: yesterday in a moment of madness I tried to run for a train (which I did actually catch) but had that 'omg my chest is killing me' moment with absolutely burning lungs, and I really thought I was going to spend the whole journey back gasping. I did have the burning chest and that feeling of wanting to cough up gunk but a couple of puffs of Atrovent seemed to ward off anything worse!

eeyore, I am puzzled by your GP. Not that I have any personal experience of this but I thought Atrovent was standard in costa if you have an attack? If I ever get to that stage I will certainly be requesting it if I can as salbutamol seems to give up when the going gets tough. On the other hand, I am hardly great for showing what works for most asthmatics as I am so weird, but most people on this thread seem to have derived some benefit!


You should read the enclosed leaflet .... Will have the information u require.... Atrovent should be taken 4 times a day and usually 6-8 hours .... Taking it more frequent may make u have the side effects


I did look at the leaflet but it didn't really help, was a bit generic and the same as the Ventolin one even though I know in reality you don't take Ventolin the way the leaflet suggests (it makes it sound like a preventer that you take regularly rather than a reliever, talked about 'if you miss a dose' and 'don't take more than prescribed' even though AUK says you can have up to 10 in 10 mins if bad).

I wasn't sure what you could do with Atrovent so thought I would ask you lovely people if you had more info and you do! So thanks.


Atrovent is standarnd emergency neb treatment usually mixed in the first neb however for its use reguallary as a preventive its uses are mainly in COPD but its becoming more popular for the weird asthmatics.

i think its classed as a long acting reliver as it can take a while to kick in!


You shouldn't take more than 8 puffs a day of the 40mg atrovent inhaler. If i was in your situation I would take one puff of your ventolin and then one puff of atrovent ( but obs not taking over 8 puffs in a day of it) when experiencing symptoms.

However I would contact your doctor to check how he wanted you to use it. He shouldn't really of prescribed it and the pharmacist should have checked you knew how to use it. So either contact your doctor or go back to the pharmacist.

Good luck.



Thanks Alice, will try that! It's actually only the 20mg one, just checked, so guessing I can have that a bit more often? Will check with pharmacist who should have said something yes, it never occurred to me to check and I didn't think till I got home that actually I wasn't sure what to do with it...

When you say the doctor shouldn't have prescribed it, do you mean not at all or just that he shouldn't have prescribed it that way and he wasn't precise enough? Am curious about what you meant there as I wasn't aware there was any particular reason not to prescribe it (and I like it already lol, they're not taking it off me now!)

Hope you're doing ok btw and that you got to celebrate your 21st at some point.


Thanks Alice! It's actually only the 20mg one, just checked, so guessing I can have that a bit more often? Will check with pharmacist who should have said something yes, it never occurred to me to check and I didn't think till I got home that actually I wasn't sure what to do with it...

When you say the doctor shouldn't have prescribed it, do you mean not at all or just that he shouldn't have prescribed it that way and he wasn't precise enough? Am curious about what you meant there as I wasn't aware there was any particular reason not to (and I like it already lol, they're not taking it off me now!)

Hope you're doing ok btw and that you got to celebrate your 21st at some point.


I also use Atrovent inhaler and I have been told to use it 2 puffs four times a day, I tend to use it every 4 hours this has been on the advise of my Respiratory Consultant


ooops sorry! that was very unclear! It's fine that he prescribed it, buttt I meant he should have given you clear instructions on how to use it! If it's the 20mg don't take more that 16 puffs in a day. I would still try one puff of ventolin then one puff of atrovent whilst experiencing symptoms.

Do check with you Dr or pharmacist tho!

Yes thanks, I got lots of celebrations in hospital and I eventually celebrated a little bit by going out for dinner to TGI's with a group of friends - didn't go on our night out tho! Never mind - there's always next year!



I also use atrovent, I take either 2 puffs twice a day or 2 puffs 3 times a day, I was prescribed it when I was admitted to hospital 1 time a few years ago and it seems to be quite helpful, but really i think you should go back to your doctor and ask them how much you should be taking, hope it helps you



Another question

I *think* I've worked out the dosage on this one, thanks to all the help from you lovely people - though will check next time I see GP which I doubt will be too long given past experience - I'm still waiting to hear back about my referral problem!

Ally, glad you did get some kind of celebration! Definitely have a big 22nd party - no-one else will so you can go mad lol.

Anyway sorry if this is really obvious - and just to say I'm not in need of the advice right now - but just wondering if you can do the 'ten puffs through a spacer' thing with Atrovent as well as Ventolin? Ventolin seems to give up long before I get to the 'hmm, should I call OOH?' stage, when I'm still not feeling too bad. Atrovent so far has been pretty good at making things better (not perfect, but definitely better) when I get more SOB and on the occasions when I've got to the 'rubbish, should I call someone?' stage - pulls me out of that. So if I did get bad I was thinking it would make more sense to do 10 puffs in 10 mins of Atrovent (20mcg) instead of Ventolin, but is this advisable? I'm sort of assuming it is because you must get about that in a neb. It would certainly help more than Ventolin usually does, I should think, and if that much Atrovent didn't work I think i would know it's time to call someone in which I never know with Ventolin because it just gives up so quickly!

Anyway sorry for the ramble! Hope this makes sense somehow... I do love Atrovent though even if it does taste minging. Really helps me sleep at night if I take 2 puffs before bed.


Interesting question, Philomena. Not sure it is advisable without checking though. I've always been told max 8 puffs a day but never asked it in that context. It does taste awful I have to agree.

Ally 18, thought it was only available in 20 and not 40mcg as well?


Hmm, I was going on the max 16 puffs as suggested by Alice! Hopefully it's not max 8, I have definitely been going over that...

Guess I will have to ask the pharmacist. Hopefully they will know the answer to this one and not just trot out what's on the leaflet - I don't want to ask my GP if I can avoid it as I want him to concentrate on my referral issue - have this feeling that I don't want to make him concentrate on too many things at the same time lol.

EDIT: Just realised who would know the answer...AUK line but they're not open till 3rd Jan! Bummer. Will just have to avoid having an attack before then.


As I said before I'm not sure but tis an interesting question & not one I have asked specifically. Maybe try phoning your GP if possible, most practices will have phone appts where poss as it saves time on physical appts.

The information leaflet does say 'Adults (including the elderly) • One or two puffs to be inhaled three or four times daily • Sometimes, in early treatment, up to four puffs at a time may be taken' = 16 puffs a day.

Good luck and let us know the answer anyway esp re 10 puffs atrovent vs ventolin



Philomela is on the 20mg inhaler so therefore if you took 16 puffs, in one day you would be having 320mgs a day which is the max dose by an inhaler, the same as taking the 40mg 8 times a day. The actual max dose of atrovent in a day as stated in the BNF is 1mg in nebuliser solution... so your fine taking the 20mg 16 times a day.

HOWEVER you should take it as prescribed by your doctor and no other way. So please contact your doctor and find out how much you should be taking. If you really don't want to do that please go and see the pharmacist who dispensed it!



Thanks Alice and sorry, you did say that before!

If I had thought of this before I could have asked the adviceline before they closed for xmas...oh well, I will try to ask pharmacist though they'll probably say the same as you. Not sure if they'll be able to help re the '10 puffs' question - from your answer it seems that would depend on how much I'd already had and tbh if I'd got to the stage of needing to do that I'd already have had a shedload. I may need to ask GP/adviceline about that one because any normal person would just do it with Ventolin but as I explained I just like to be awkward lol

I will let you know if/when I have an answer to this.


Ally18, just wondering where you got the 40mcg inhaler from as I didn't know there was one.

Does it help minimise the awful taste as less puffs?


Update on how much to take

Well for all those interested I may have an answer to the question about how to use Atrovent, though not 100% convinced...

Had to ring OOH AGAIN tonight about post-gym dizziness (nothing new but I felt even worse tonight than last night after gym and couldn't work out if it was my cold or the stupid dizziness really acting up that was making me feel rubbish. They must think I am such a hypochondriac but it's kind of hard to tell - had really long convo with NHS Direct first about whether it could be the cold on its own).

Anyway...he said 'as you're asthmatic and have a cold, be careful, ring us back if you feel really breathless during the night'. So I decided to ask him about whether I could use Atrovent the same way as Ventolin and explained my problem.

He said you shouldn't take as much - he said with Ventolin it should be 2 puffs, then try 4 if no better etc every 5 mins up to 10 puffs but not to do this with Atrovent - APPARENTLY I should just try taking it, see how it goes and ring them if it doesn't seem to be helping, but obviously not to hit it like the Ventolin.

He then nearly made me crack up though - said 'we usually recommend one puff of Atrovent a day, how much do you usually have?'

I said...'ummm, one puff a day? Try more like 8 a day...' He sounded a bit startled by that and asked me how much I'd been prescribed, and I said it was 2 puffs with symptoms so 6-8 a day on average was about right. He must think I am some kind of crazed addict but what good is one puff a day?! That's not going to get me anywhere...this is why I was a little sceptical about his answer. But he seemed ok in general and it did make sense, though I still don't know how much is enough before giving up and calling in the cavalry (it took about 4 puffs in a short space of time the other evening to calm things down but I was ok after that).

Anyway sorry for the ramble...just thought this might be useful to share!


Thanks Philomena. Not sure about NHS Direct from experience but that's another story. Sounds odd that GP esp as BNF which GPs use advises 20-40mcg 3-4 times daily. Have just been told unhelpful by cons that Atrovent is so old fashioned, no good for asthma & better for older COPD patients. Erm I did just tell you it has made the most difference this year for me & kept me off pred so far?!

Edit to complete as posted too early


Yeah I was a bit puzzled, not really sure what one puff a day is going to do?! But thought I would going to ring AUK tomorrow I think as still puzzled, will update if anything useful/different from that.

Agree re NHS Direct - I really don't know why I bother as they always refer me to OOH but whenever I have rung them I generally feel like I am being a major hypochondriac and shouldn't go straight to OOH, and maybe NHS Direct will be able to just give me advice. I never seem to remember that if you ring up with dizziness/sob they are going to want to be careful and will always pass on to OOH!

Plus it's confusing when they say one thing very definitely and OOH says another (though actually the first time this happened I feel NHS Direct had the right of it even though I know they can be over-cautious. I rang up SOB and all the Ventolin I'd taken hadn't worked; NHS though see someone, OOH said 'nah, you don't need to, but if you really want to I guess you can come in, up to you'. I was fine in the end, but kind of feel OOH should not have been quite so definite over the phone, when my reliever was not working, that I was fine.)

Anyway sorry for random digression...


Another update

Well, saw GP, said I was a bit confused but it seems to work, and he said to take it like Ventolin! So that's what I will do though will bear in mind it shouldn't be knocked back at the rate I was going through Ventolin. Still, if it actually works, I shouldn't need to.

He also said my response to Atrovent was another indicator (like my response to montelukast) that my asthma is mainly exercise-induced - apparently Atrovent works especially well for this.


Strange conflicting advice we're given on how to take it? Didn't know that about Atrovent and exercise.


yeah that's what confused me, so I specifically asked whether to take it like Ventolin and he said yes! Though since this is what I wanted to do anyway... Could have gone into it more but had a lot to discuss anyway (20 mins in there) so didn't want to spend too long on this.


You may also like...