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Combining a beta-2 agonist with an anticholinergic drug

BMJ Group Medical Reference


This information is for people who have chronic obstructive pulmonary disease (COPD). It tells you about combining two drugs for COPD, called beta-2 agonists and anticholinergic drugs. This information is based on the best and most up-to-date research.

Does it work?

Yes. Taking two drugs to open up your airways can help you if you have chronic obstructive pulmonary disease (COPD). Taking a beta-2 agonist and an anticholinergic drug may help your breathing more than using just one of them on its own.

What are they?

If you've tried using an inhaler to help you breathe and you still get symptoms, your doctor might suggest using two different types of drug. You can use two inhalers together, or you may be able to use an inhaler that contains two drugs.

You might be prescribed a combination of drugs including a beta-2 agonist and an anticholinergic drug. Both come in short- and long-acting versions.

You usually use short-acting inhalers whenever you're having trouble breathing. Alternatively, your doctor might advise you to use your inhaler at regular intervals, three or four times a day, to keep your airways open.

Long-acting inhalers don't work very quickly, so they aren't used for fast relief when you have a sudden breathing problem. Instead, you take them regularly, maybe twice a day, to keep your airways open.

Anticholinergic drugs

This type of drug opens up your airways by relaxing the muscles in your lungs. Sometimes anticholinergic drugs are called bronchodilators because they open up (dilate) your airways (bronchial tubes).

Short-acting anticholinergics work quickly and last for three to four hours. The one that's usually used is called ipratropium (Atrovent).

Long-acting anticholinergics last for a long time. So you need to take them only once a day. The only type available in the UK is called tiotropium (Spiriva). It comes as capsules that you put into an inhaler called a HandiHaler.

Beta-2 agonists

These inhalers relax the muscles in your lungs so that your airways can open up. This should help you breathe more easily.

Short-acting beta-2 agonists work quickly and last for three to four hours. Examples (with brand names) include:

Long-acting beta-2 agonists take longer to start working (15 minutes to 30 minutes) but go on working for up to 12 hours. Examples (with brand names) include:

Combination inhalers

You can get inhalers that contain both an anticholinergic drug and a beta-2 agonist.

  • Combivent contains ipratropium and salbutamol. You can't get this combination as an inhaler. It comes as capsules of liquid that you use with a compressed air spray (a nebuliser).

  • Duovent contains ipratropium and fenoterol.

Inhalers and nebulisers

The metered-dose inhaler (MDI) is the most common kind. It's a small plastic holder with a slot where you put an aerosol canister. Pressing on the canister releases exactly one dose of the medicine. It comes out as a puff of tiny droplets that you slowly breathe in through your mouth.

Last Updated: March 13, 2013
This information does not replace medical advice.  If you are concerned you might have a medical problem please ask your Boots pharmacy team in your local Boots store, or see your doctor.

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