Ipratropium bromide (Atrovent®) and Tiotrpium Bromide (Spiriva®) are medications that prevent the muscle bands around the airways from tightening. Atrovent® is available for use as a metered dose inhaler and in a solution for a nebulizer. Spiriva® is available for use in a HandiHaler®.

Like short-acting beta agonists (e.g. albuterol), they are bronchodilators, relaxing the muscle bands around the airways. However, short-acting beta agonists relax the muscle bands after they are already tight. Ipratropium bromide (Atrovent®) and Tiotropium bromide (Spiriva®) prevent the muscle bands from tightening.

For that reason, they are controller medicines. These medicines are most commonly used to treat chronic obstructive pulmonary disease (COPD). They may be used if a doctor suspects a person has both asthma and COPD.

Caution: It is important to place the Atrovent ® inhaler in the mouth with this medicine. Otherwise, the spray from the inhaler can come in contact with the eyes, causing the pupils to dilate.

Controller Medications:

• Prevent asthma symptoms from occurring
  
• Can reduce and/or prevent:
  • Inflammation and scarring in the airways
    
  • Tightening of the muscle bands around the airways (bronchospasm)
• Do not show immediate results, but work slowly over time
  
• Should be taken daily, even when you are not having symptoms
  
• Should NOT be used to relieve immediate asthma symptoms

A Note about Long-Term Controller Medicines in Children

According to the National Asthma Education and Prevention Program at the National Institutes of Health, long-term controller medicines should be considered when infants or young children have had three or more episodes of wheezing in the previous year and who are at an increased risk of developing asthma because of their own or their parents' history of allergic diseases. They also recommend long-term controller medicines for children who need short-acting bronchodilators (rescue medicines) more than twice a week or have had severe asthma symptoms less than six weeks apart. Without a controller medicine, the underlying inflammation will continue to cause more asthma symptoms.

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