Anticholinergics in Asthma treatment

Anticholinergics inhibit muscarinic cholinergic receptors and reduce intrinsic vagal tone of the airway.

In general, anticholinergics are not first-line therapy for asthma.
According to the NAEPP guidelines, they may be used in conjunction with SABA in severe exacerbation in the emergency department.
The addition of ipratropium has not been shown to provide further benefit once the patient has been hospitalized.

For adults, the doses for ipratropium bromide for asthma exacerbation,
Nebulized solution (0.25 mg/mL): 0.5 mg or 500 mcg every 20 minutes for 3 doses, then as needed.

Albuterol and ipratropium are often mixed in the same nebulizer. If given concurrently, the dosing of albuterol and ipratropium is:

Nebulizer (each 3ml vial contains 2.5 mg albuterol + 0.5 mg ipratropium bromide):

3 mL every 20 minutes for 3 doses, then as needed. This regimen may be used for up to 3 hours in the initial management of severe exacerbations although the addition of ipratropium to albuterol has not been shown to provide further benefit once the patient has been hospitalized

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