Pharmacological Management of Chronic Obstructive Pulmonary Disease Utilizing Ipratropium Bromide and Nursing Implications

Pharmacological Management of Chronic Obstructive Pulmonary Disease Utilizing Ipratropium Bromide and Nursing Implications

In nursing, pharmacological management of diseases is vital. Whereas some disorders can be treated and managed without using drugs, others require administration of medication. The use of medicines for treatment, knowing their effects and mode of action constitute pharmacological management. One of the diseases that need medicaments to manage is called chronic obstructive pulmonary disease (COPD), and among the drugs that are utilized for treating the condition is ipratropium bromide.

Chronic obstructive pulmonary diseaseis the leading cause of persistentmorbidity and mortality across the world (Pauwels, Buist, Calverley, Jenkins & Hurd, 2001). Currently and globally, COPD is the fourth prominent cause of death. By definition, COPD refers to a condition depicted by increasing breathlessness (Pauwels et al., 2001). Put differently, COPD is a general terminology used to describe a wide range of progressive lung diseases such asemphysema and non-reversible asthma. Some of the symptoms of COPD include coughing, dyspnea, and production of sputum. COPD is a fatal condition, and persons exhibiting the mentioned symptoms should seek medical attention immediately.

Ipratropium bromide, also known as Atrovent, is classified as anticholinergic and is recommended for treating COPD and asthma. According to Marshall (2018), when used regularly, it unblocks the airways enabling patients to breathe easily. When Ipratropium bromide is taken together with tiotropium, there are no significant drug interactions as the drugs are negligibly absorbed into the systemic circulation after inhalation(Woo, Robinson & Woo, 2015). When Atrovent is mixed with cromolyn sodium, a precipitate is formed (Woo et al., 2015). Patients are therefore advised to stick to physicians’ prescription when using Ipratropium bromide.

Anticholinergics have a similar mechanism of action. When inhaled, ipratropium bromide blocks muscarinic cholinergic receptors and reduces the creation of cyclic guanosine monophosphate, which causes the smooth muscle of the lungs to lose some contractility (Woo et al., 2015). Subsequently, the action of ipratropium bromide causes the airways to open, making it possible for patients to inhale better. These actions of the ipratropium bromide constitute its pharmacodynamics. The relatively fast mode of action of Ipratropium bromidemakes it the most preferred medication for COPD.

Pharmacokinetics of ipratropium bromide entails absorption and distribution, and metabolism and excretion. When inhaled, only 1% to 2% of ipratropium bromide is systematically absorbed into the body. About 90% of ipratropium bromide dose is ingested and excreted unaffected. The fraction of the absorbed dose is partly metabolized to inactive metabolites (Woo et al., 2015). About half of the absorbed ipratropium bromide is expelled untouched in the urine (Woo et al., 2015). Experts have a role in developing a more effective and economical form of ipratropium bromide.

Ipratropium bromide is used to treat a variety of conditions. According to Marshall (2018), it treats asthma and COPD. The dose of ipratropium bromide for adults equals two inhalations four times in 24 hours (Woo et al., 2015). The number of puffs per day may range between 8 and 12. Also, ipratropium bromide can be mixed with albuterol if utilized within an hour. Patients using Ipratropium should be careful and adhere to doctors’ prescription.

A wide range of adverse reactions of ipratropium bromide has been reported. Among the reactions include coughing, hoarseness, nausea, vomiting, and throat irritation (Woo et al., 2015). Whereas a substantial number of patients experience some of these adverse reactions, a reaction known as xerostomia is experienced by 2% only of the patients. The benefits of ipratropium surpass its limitations.

Nursing implications of ipratropium bromide are minimal. According to Marshall (2018), patients who may require extra monitoring while under ipratropium bromide medication are those with glaucoma, cystic fibrosis, and prostatic hypertrophy. Nurses, therefore, should ensure that patients with the above-mentioned conditions and usingipratropium bromide are given extra care.

Contraindication refers to a condition which makes a specific medication inadvisable. Persons who are allergic to ipratropium bromide or any other related drugs are advised not to use it. Additionally, people who are allergic to any ingredient of the medicine are discouraged from using it (Marshall, 2018). Patients, therefore, should know the components of ipratropium bromide and avoid using it if it contains elements that cause the allergies.

Ipratropium bromide is administered through the nostrils.  Atrovent inhaler should be used thrice in a day. For the adults, one or two puffs three to four times daily are recommended. Children aged between 6 and 12 years should use one to two puffs thrice in a day (Marshall, 2018). For the medicine to be effective, it is critical to adhere to the recommended dosage, and use of the right route.

Equipping patients with the right information about ipratropium bromide is imperative in managing COPD. Patients should follow the drug’s prescription well to avoid any drug abuse. Patients should be informed about the side-effects of the medication prior to using it. Most importantly, patients should learn how to use the inhaler correctly. Informed and responsible patients make the management of COPD using ipratropium bromide a success.

In conclusion, COPD is a condition characterized by progressive breathlessness. Ipratropium bromide is useful in the pharmacological management of COPD. Administering the drug correctly and educating patients about the medicine result in successful management of COPD.



Marshall, H. (2018, March 26). Atrovent (ipratropium bromide). Retrieved from

Pauwels, R., Buist, A., Calverley, P., Jenkins, C., & Hurd, S. (2001). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. American Journal of Respiratory and Critical Care Medicine, 163(5), 1256-1276. doi: 10.1164/ajrccm.163.5.2101039

Woo, T. & Robinson, M. (2015). Pharmacotherapeutics for advanced practice nurse prescribers with Davis Plus eResourses, 4th ed. F.A. Davis Company. ISBN: 9780803638273


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