Atrovent Inhaler (Ipratropium Bromide) for COPD & Breathlessness

Atrovent is an inhaler containing ipratropium bromide, a short-acting muscarinic antagonist (SAMA) bronchodilator. It’s licensed for regular treatment of narrowed airways in COPD and chronic asthma, and in the UK it’s mostly used in COPD. It opens the airways in a different way from Ventolin, so the two can be used together. Ipratropium is also given through a nebuliser in hospital during severe attacks; we supply the inhaler only.

Both Ventolin and Atrovent open up the airways, but they push different buttons to get there. Ventolin tells the airway muscles to relax by stimulating beta-2 receptors. Atrovent works by blocking a different receptor — the muscarinic receptor — which the body uses to keep the airways slightly tightened in the background. By blocking that signal, Atrovent allows the airways to ease open. A useful way of thinking about it is that Ventolin actively pushes the muscle to relax, while Atrovent removes a constant pull that's keeping the muscle tight.

Atrovent starts to work within about 15 minutes, is at its strongest after 1 to 2 hours, and lasts about 4 hours. Ventolin works within a few minutes, which is why Ventolin, not Atrovent, is the inhaler to use for sudden symptoms.

Atrovent isn’t usually a replacement for Ventolin; most people who use it also have a salbutamol reliever. It’s mainly used in COPD, where a short-acting antimuscarinic such as ipratropium is one of the first treatments to try. It’s sometimes added in asthma when a reliever alone isn’t enough. Your GP or nurse decides which inhalers suit you.

The usual adult dose is 1 or 2 puffs (20 micrograms each) three or four times a day. Some people are prescribed up to 4 puffs at a time when they first start. Don’t take more than your prescribed dose, and follow the plan your GP or nurse has given you.

Common side effects include headache, dizziness, dry mouth, throat irritation, cough, feeling sick and changes in bowel habit, such as constipation or diarrhoea. Watch out for spray getting into your eyes: it can cause eye pain or blurred vision and, in people at risk, acute glaucoma, which needs same-day treatment. Using a spacer and good technique make this much less likely.

Yes. Atrovent needs care if you have glaucoma or are at risk of it, an enlarged prostate or difficulty passing urine, or cystic fibrosis. Long-term use alongside another antimuscarinic inhaler, such as tiotropium, isn’t recommended. You shouldn’t use it if you’re allergic to ipratropium or atropine. Tell the prescriber about any of these.

We only supply Atrovent to adults aged 18 and over. Children can be prescribed it by their GP or hospital team. In pregnancy and breastfeeding, the product information says to use it only if the benefit is greater than the risk, because there’s little experience of it. Poorly controlled breathing is also a risk to you and your baby, so don’t stop your inhalers. Tell us if you’re pregnant or breastfeeding and we’ll share the consultation with your GP.

Yes. They work in different ways, so they can be used together, and many people with COPD use both: Atrovent regularly, and Ventolin when they have sudden symptoms. Follow the plan your GP or nurse has given you. If you’re struggling to breathe, use your reliever and call 999 if it isn’t helping.

Atrovent (ipratropium) is short-acting: it lasts about 4 hours and is taken three or four times a day. Long-acting antimuscarinics (LAMAs), such as tiotropium (Spiriva), umeclidinium or glycopyrronium, are taken once a day and last 24 hours. They belong to the same family of medicines, and the product information says using Atrovent long term alongside another antimuscarinic isn’t recommended. So when a LAMA is started, your GP or COPD nurse will usually stop Atrovent. Your GP or COPD nurse will advise.

No. Atrovent works too slowly to help in an attack. Use your reliever, and call 999 if it isn’t helping, you’re too breathless to speak, or your lips or fingertips turn blue or grey.

Yes. Atrovent is a prescription-only medicine, so you can’t buy it over the counter in the UK. We can supply it after a short online consultation with one of our prescribers, if you’re an adult who already uses it, and with your consent we let your GP know.

Neither, exactly. It’s a bronchodilator that opens the airways, mainly used in COPD, either regularly or when you’re breathless, depending on your plan. It isn’t a steroid preventer like Clenil, and it’s slower than a salbutamol reliever like Ventolin, so don’t rely on it for sudden symptoms.

No. Each inhaler holds 200 puffs, and you can’t see how much is left. At 2 puffs four times a day, one lasts about 3 to 4 weeks. Keep a note of how many puffs you’ve used and order a new one in good time.

Yes. Atrovent is the brand name; ipratropium bromide is the active ingredient. Other ipratropium inhalers are available in the UK, but they can feel different to use, so we supply the one you’re prescribed.