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This airway narrowing causes symptoms such as wheezing, shortness of breath, chest tightness, and coughing, which respond to bronchodilators.

Physicians caring for patients with COPD need to follow closely the statements on compounding from the Food and Drug Administration and professional societies to ensure that patients receive safe combination aerosol therapy.

Albuterol in higher dosages has been reported to aggravate angina, myocardial ischemia, or cause atrial or ventricular arrhythmias.

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Mettauer B, Rouleau JL, Burgess JH "Detrimental arrhythmogenic and sustained beneficial hemodynamic effects of oral salbutamol in patients with chronic congestive heart failure.

Long-acting beta-agonists in the management of chronic obstructive pulmonary disease: current and future agents.

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Goodman DE, Israel E, Rosenberg M, Johnston R, Weiss ST, Drazen JM: The influence of age, diagnosis, and gender on proper use of metered-dose inhalers.

Hypersensitivity reactions including urticaria, angioedema, rash, bronchospasm, anaphylaxis, and oropharyngeal edema may occur after the administration of Atrovent HFA.

Do not use the mouthpiece with other medicines.

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In patients with chronic bronchitis or chronic obstructive pulmonary disease (COPD), treatment with mucolytics has been associated with a small reduction in acute exacerbations and a reduction in the total number of days of disability.

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Patients should also be counseled on the common AEs, including menstrual irregularities, GI upset, cramping, nausea, vomiting, breast tenderness, and changes in vaginal discharge.

Anticholinergics prevent the increases in intracellular concentration of cyclic guanosine monophosphate (cyclic GMP) that are caused by interaction of acetylcholine with the muscarinic receptor on bronchial smooth muscle.

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To use the solution with a nebulizer, place the liquid into the medication chamber of the apparatus, attach the mouthpiece or face mask to your mouth, and activate the machine.

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The short-acting anticholinergic ipratropium bromide and the short-acting β 2-adrenergic receptor agonist fenoterol hydrobromide have been available for combined use both as a pressurized metered-dose inhaler and as a solution for nebulization.

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Allergic reactions may occur, including itching, swelling of the face, lips, tongue, or throat (involving difficulty in breathing or swallowing), rash, hives, bronchospasm (airway narrowing), or anaphylaxis.

CFC response on this initial test day.

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The addition of ipratropium, a synthetic cholinergic antagonist, to beta2-agonist therapy provides an additive improvement in adult with acute severe asthma and COPD because of increased vagal tone in the airways.

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In a separate report, Kilfeather and coworkers describe the results of a similar study, which involved 892 patients with moderate to severe COPD ().

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