Symptoms of COPD

COPD is one of those diseases that often do not show any symptoms until the disease has progressed to an advanced stage. The conditions are often diagnosed when the lungs have already been significantly damaged.

While symptoms of COPD can vary across patients, the diseases are mainly characterized by:

  • Shortness of breath that continues to increase with time, if not treated. A patient can experience breathlessness while performing a physical activity
  • Regular coughing, both with and without mucous
  • Wheezing
  • A feeling of tightness in the chest
  • Frequent respiratory infections
  • Swelling in the legs, feet, and/or ankles
  • Chronic cough that may also produce greenish, yellow, white, or clear mucus
  • Waking up with an excess of mucus in the lungs. A patient may require to clear their throat immediately after waking up
  • Lack of energy
  • Weight loss during the later stages of the disease
  • One of the main symptoms of chronic bronchitis is daily cough with mucus production for about three months a year, for two consecutive years.

People suffering from a COPD condition often experience several day-long episodes during which their symptoms get worse than usual.

Treatment for COPD

Depending on the severity of the condition, causes, family history and the overall health of a patient, the treatment plan for COPD may include one or a combination of bronchodilators, steroids, enzyme inhibitors, and anticholinergics. The doctor may also prescribe mucolytic agents and antibiotics as well as may also suggest the patient to perform yoga or endurance exercises.

While not very common, the doctor may suggest a surgery for treatment of COPD. These surgeries include lung volume reduction, bullectomy, and in worst cases, a lung transplant.

No matter what treatment plan the doctor lays out for a patient, it almost always includes using a bronchodilator.

What Is a Bronchodilator?

A bronchodilator is a medicine, or a combination of medicines, that helps to relax the muscles surrounding the airways. As a result, the airways get enlarged or dilated, which then will make it easier for the air to flow through the respiratory passage.

Bronchodilators are available in two types: short-term and long-term.

Combivent Respimat for COPD

As mentioned earlier, Combivent Respimat is prescribed to patients suffering from narrowed airways, but do not find relief from other generally used COPD medications.

How Combivent Respimat Works

While both the drugs found in Combivent Respimat are bronchodilators, their mechanism of action is different.

Albuterol sulfate is a type of drug that falls into the category of beta-2 agonist bronchodilators.  The drugs that belong to this category specifically act on beta-2 receptors found on the muscle cells on the lining of the airways and cause them to relax. As a result, the airways get opened and the patient finds relief from breathlessness.

Ipratropium bromide, on the other hand, helps to suppress or cancel the effects of acetylcholine in the nasal passage and airways. Acetylcholine is a neurotransmitter that the cholinergic nerves use to regulate functions like, airway smooth muscle contraction, airway tone, vasodilation, and mucus secretion.

In patients of COPD, the cholinergic nerves that go to the lungs produce excessive amount of acetylcholine, which causes increased contraction of muscle cells surrounding the airways. As a result, the patient experiences shortness of breath due to narrowing of airways.

Ipratropium bromide promotes muscle relaxation and dilation of airways by blocking out the effects of cholinergic nerves and acetylcholine.

Can Combivent Respimat Be Used as a Rescue Inhaler?

No, Combivent’s mechanism of action is not fast enough to provide immediate relief in case of flare ups. For most patients, the medicine takes around 15 minutes to provide relief.


Combivent Respimat inhalation spray is available in two varieties: 90/18 mcg and 100/ 20 mcg per actuation

Each actuation of the inhaler provides 90 or 100 mcg albuterol sulfate and 18 or 20 mcg ipratropium bromide.

Recommended Dosage

Belonging to the category of short-acting bronchodilators, Combivent Respimat only stays in the patient’s body for 4 to 6 hours. Hence, it needs to be administered multiple times in a day.

On average, one inhalation of Combivent Respimat is prescribed to be administered four times a day. Some patients may be recommended to take more inhalations, if necessary, however, the dosage should not exceed six inhalations in 24 hours.

Always consult your doctor to determine the right dosage for yourself and do not change it on your own. If you feel that the prescribed dosage is not providing enough relief, talk to your doctor and do not increase the dose of the medicine on your own.

Possible Side Effects of Combivent Respimat

While a lot of patients who use Combivent Respimat do not experience any side effects at all, there is a probability that you may experience on or more of the following effects while on this medication:

  • Headache
  • Dry mouth
  • Nausea
  • Vomiting
  • Cough
  • Dizziness
  • Nervousness
  • Tremors
  • Constipation
  • Cold and flu like symptoms, such as sore throat, cough, sneezing, and/or stuffy nose
  • It may also cause an increase in the blood pressure

Infrequent Side Effects of Combivent Respimat

Some patients may experience following effects when on Combivent Respimat[1]:

  • Backache
  • Severe trouble in sleeping
  • Anxiety and/or depression
  • Excessive sweating
  • Fever
  • Hyperactivity
  • Indigestion
  • Cramps in legs
  • Ringing in the ears
  • Inflammation of nose
  • Water retention
  • Migraine
  • Uncoordinated movements

Serious Side Effects of Combivent Respimat

While not common, Combivent Respimat may also cause some serious side effects, such as:

  • The worsening of breathing issues and bronchospasms.
  • Urinary retention
  • Irregular or fast heartbeat
  • Chest pain
  • Palpitation
  • Ocular or visual changes

Immediately discontinue the usage, if you experience any of the serious effects and tell your doctor as soon as possible.

Possible Drug Interactions of Combivent Respimat

Combivent Respimat may interact with the medications taken for the following health conditions:

  • Urinary or bladder issues
  • Parkinson’s disease
  • Depression
  • Blood pressure
  • Heart diseases
  • ADHD
  • Stomach ulcer
  • Motion sickness
  • Irritable bowel syndrome
  • Diet pills
  • Diuretics, commonly known as water pills

The drugs found in the bronchodilator may also interact with the chemicals found in some over-the-counter allergy and cold medicines.

In view of the possibility of interaction, it is recommended to always tell your doctor about any and all the medications and supplements you are using.

While it is unknown if the drugs found in Combivent Respimat pass into breast milk or if they can have any negative effect on the baby, the medicine is not recommended to be used by nursing mothers.

Who Should Not Take Combivent Respimat?

People suffering from following diseases or health conditions should not use the bronchodilator:

  • Hypertension
  • Ketoacidosis
  • Abnormal heart beat
  • Seizures
  • Reduced or inadequate blood flow through the arteries of the heart and to the heart muscles
  • Urinary bladder blockage
  • Closed angle glaucoma
  • Enlarged prostate
  • Low levels of potassium
  • Excessive amount of body acid

Combivent Respimat should be used with caution in patients suffering from the following conditions:

  • Hyperthyroidism
  • Diabetes
  • Convulsive disorders
  • People who are highly sensitive or overly responsive to any of the drugs

Bottom Line

Combivent Respimat is a prescription medication that is highly effecitve for treating narrowing of the airways, called bronchospasm, caused by any of the COPD conditions. Since Combivent Respimat contains two active drugs, it is more powerful than a regular bronchodilator and hence, is only prescribed to patients who do not benefit from a regular medication and need a second or a stronger dosage.

The medicine may cause some side effects and drug interactions, so it should never be used without consultation with a doctor. Even when prescribed by a pulmonologist, watch out for any negative effects and immediately tell the doctor, if you experience any side effect. Lastly, do not change the dosage or the frequency of Combivent Respimat on your own.

Combivent Respimat Prescription Assistance

Have you been prescribed Combivent Respimat by your doctor, but you do not have insurance and cannot afford to buy it on your own?

Don’t worry – prescription assistance for Combivent Respimat is available!

Boehringer Ingelheim Cares Foundation, INC. offers this medicine at a very low-cost, or even for free, under their patient assistance program. For details about the assistance program and how to apply,visit the website of Partnership for Prescription Assistance or click here to check out the eligibility criteria to receive assistance for Combivent Respimat.