Ipratropium

INTRODUCTION

Indications

Inhalation: Maintenance therapy of reversible airway obstruction due to COPD, including chronic bronchitis and emphysema. Intranasal: Rhinorrhea associated with allergic and nonallergic perennial rhinitis (0.03% solution) or the common cold (0.06% solution). Unlabeled Use: Inhalation: Adjunctive management of bronchospasm caused by asthma.

Action

Inhalation: Inhibits cholinergic receptors in bronchial smooth muscle, resulting in decreased concentrations of cyclic guanosine monophosphate (cGMP). Decreased levels of cGMP produce local bronchodilation. Intranasal: Local application inhibits secretions from glands lining the nasal mucosa. Therapeutic Effects: Inhalation—Bronchodilation without systemic anticholinergic effects. Intranasal: Decreased rhinorrhea.

Adverse Reactions/Side Effects

CNS: dizziness, headache, nervousness. EENT: blurred vision, sore throat, nasal only: epistaxis, nasal dryness/irritation. Resp: bronchospasm, cough. CV: hypotension, palpitations. GI: GI irritation, nausea. Derm: rash. Misc: allergic reactions.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Assess pulmonary function at rest and during exercise (See Appendices I, J, K) to document effectiveness of medication in controlling bronchospasm in asthma and COPD.

• Monitor signs of paradoxical bronchospasm (wheezing, cough, dyspnea, tightness in chest and throat), especially at higher or excessive doses. If condition occurs, advise patient to withhold medication and notify physician immediately.

• Be alert for signs of allergic reactions, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician or nursing staff immediately if these reactions occur.

• Assess blood pressure periodically and compare to normal values (See Appendix F). Report low blood pressure (hypotension), especially if patient experiences dizziness or syncope.

• Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

Interventions

• Design and implement appropriate aerobic exercise and respiratory muscle training programs to maintain optimal cardiovascular and pulmonary function. Work with patient and family/caregivers to find forms of exercise (e.g., swimming) that can help improve respiratory function without triggering bronchoconstrictive attacks.

• When implementing airway clearance techniques or respiratory muscle training, attempt to intervene when the airway is maximally bronchodilated. Peak responses typically occur 1–2 hr after inhalation.

Patient/Client-Related Instruction

• Advise patient to not exceed the recommended dose or frequency of inhalations. Contact physician immediately if bronchospasm is not relieved by medication or is accompanied by diaphoresis, dizziness, or other symptoms.

• Counsel patient on proper use of inhaler or nebulizer; observe use of these devices whenever possible to ensure proper technique.

• Instruct patient and family/caregivers to report troublesome side effects such as severe or prolonged headache, nervousness, blurred vision, sore ...