Metered-dose inhaler by means of a spacer is just as good as nebulizer if you give about 6 to 8 activations by a spacer to equal one nebulized treatment. Reduces return visits, admission rates. For adults 125 mg IV and 40 mg IV Q6h. All evidence indicates that steroids given orally are just as effective as IV in acute exacerbations of asthma. There is no increase in relapse without taper and no adrenal suppression with a 1-week course.
Anticholinergics seem to work better in COPD than asthma but do have some bronchodilating effect.
May mix with beta-agonists in same nebulizer. May increase heart rate and may cause pupils to dilate from contact with mist. Ipratropium can be used by metered-dose inhaler and is available in a nebulized form. The dose is 0.5 mg by nebulizer. This is preferred over atropine, since there is little systemic effect.