In patients with cystic fibrosis (CF), mucus that accumulates in the lungs can block the airways, causing difficulties such as wheezing and shortness of breath. Bronchodilators are medications that help to relax and open the airway, making it easier to breathe.

Combivent Respimat is an aerosol inhaler developed by Boehringer-Ingelheim that contains a combination of two bronchodilators, albuterol and ipratropium. Combivent UDV is a nebulizer with the same combination of bronchodilators.

Combivent is recommended as the starting bronchodilator therapy for CF patients by the Cystic Fibrosis Foundation and The CF center at Stanford.

Both these treatments are specifically approved for people with chronic obstructive pulmonary disease, or COPD.

How Combivent works

Both albuterol and ipratropium help dilate the airways but function differently. They belong to two different classes of bronchodilators.

Albuterol is a beta-2-adrenergic receptor agonist. Beta-2-adrenergic receptors are present on the smooth muscles in the airways. When stimulated, these receptors relax the smooth muscles and open the airways. As an agonist, albuterol binds and activates these receptors helping to open airways. Activating the receptors also triggers the release of anti-inflammatory agents, thereby helping to resolve inflammation and improve the functioning of the airways.

Ipratropium is an anticholinergic agent. Acetylcholine is a neurotransmitter, or chemical messenger that carries information between nerve cells. In the lungs, acetylcholine can direct the nerve cells around muscles to contract, leading to the narrowing of the airways and breathing difficulties. Ipratropium can bind to and inhibit (block) the activity of acetylcholine. In this way, it helps to relax the muscles around the airways and facilitate breathing.

Combivent in clinical trials for CF

No clinical trials have evaluated Combivent specifically in patients with CF. However, a number of trials have tested the treatment in other respiratory conditions, such as chronic obstructive pulmonary disorder (COPD) and asthma.  Their results are a reason these medications may be prescribed to people with CF, as a way of preventing  bronchospasms (a sudden constriction of the airways).

A Phase 3 clinical study (NCT00400153) compared the efficacy of Combivent Respimat with its previous metered dose inhalation formulation, Combivent MDI and ipratropium inhalation spray. A total of  1,480 COPD patients (ages 40 and older) randomly received one of the three treatments or placebo. Lung function was measured by the maximum amount of air that can be forcibly exhaled in one second (forced expiratory volume 1; FEV1). Several FEV1 measurements were taken before and after the treatment. Findings showed that Combivent Respimat was equally effective compared to its predecessor in clearing airways and improving lung capacity and function.

A Phase 4 trial (NCT00273962), compared the effect of Combivent UDV to albuterol alone in improving lung function and breathing in children with asthma.

Other information

As an inhalation spray, Combivent Respimat is reported to ease breathing in as little as 15 minutes after use. According to the manufacturer, Combivent inhaler or nebulizer, used three to four times a day, aid in opening the airways. However, the usage recommendation for Combivent depends on the individual needs of each patient and the condition being treated. CF patients must consult their pulmonologist or CF specialist before using Combivent.

The common side effects of Combivent use include nausea, dizziness, tremors, headache, dry mouth, and cold and flu-like symptoms such as runny nose. Some of the less common side effects are bladder pain, blurred vision, chest pain, diarrhea, and eye pain.

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