Combair HFA

Indications

Combair Inhalation Aerosol is prescribed for individuals with Chronic Obstructive Pulmonary Disease (COPD) who are already using a regular aerosol bronchodilator but continue to experience bronchospasm. It is intended for patients who require an additional bronchodilator to improve their respiratory condition.

Note: Use this medication as directed by a registered healthcare professional.

Pharmacology

Combair Inhalation Aerosol combines two active ingredients: Salbutamol (as Sulphate) and Ipratropium Bromide. It utilizes an environmentally friendly hydrofluoroalkane (HFA) propellant instead of chlorofluorocarbon (CFC), which is known to contribute to ozone depletion.

• Salbutamol acts as a short-acting beta-2 adrenergic bronchodilator, helping to relax and open the airways.
• Ipratropium Bromide is an anticholinergic bronchodilator that works by inhibiting acetylcholine from binding to muscarinic receptors, preventing excessive constriction of the airways.

When used together, these two components work through distinct mechanisms—sympathomimetic and parasympatholytic—providing a more effective bronchodilatory effect than when used separately. This combination is designed to alleviate bronchospasm in COPD patients by improving airflow and lung function.

Dosage

For adults, including the elderly, the recommended dose is 2 puffs of Combair four times daily. Patients may take additional puffs if needed, but the total daily dose should not exceed 12 puffs. Follow your doctor’s instructions regarding dosage adjustments.

Note: Use this medication only as prescribed by a registered healthcare provider.

Administration

While using an inhaler may seem simple, proper technique is crucial to ensure the medication reaches your lungs effectively. Incorrect use can reduce the amount of medicine delivered to your lungs. Follow these steps for optimal use:

1. Remove the cap from the inhaler.
2. Shake the inhaler vigorously for at least 6 times before use.
3. If the inhaler is new or hasn’t been used in a while, release a puff into the air to ensure it works.
4. Exhale fully and hold the inhaler upright.
5. Place the mouthpiece between your teeth and seal your lips around it.
6. Inhale deeply and slowly while pressing down on the inhaler to release the medication.
7. After inhaling, hold your breath for at least 10 seconds (or as long as comfortable).
8. If multiple puffs are prescribed, wait 1 minute between inhalations and repeat steps 4 to 7.
9. Replace the cap after use, and rinse your mouth with water to avoid side effects.

For cleaning, wash the plastic actuator and cap weekly with warm water (do not immerse the metal canister). Dry thoroughly before reassembling.

Note: Always follow the guidance of your registered healthcare professional when using this inhaler.

Drug Interactions

Combair Inhalation Aerosol may be used alongside other medications like sympathomimetic bronchodilators, methylxanthines, and steroids, which are commonly prescribed for COPD. However, no specific interaction studies have been conducted.

• Caution is advised when using Ipratropium Bromide with other anticholinergic agents or sympathomimetics, as this can increase the risk of cardiovascular side effects.
• Beta-2-agonists like Salbutamol should be used cautiously in patients on non-potassium-sparing diuretics, monoamine oxidase inhibitors, or tricyclic antidepressants.

Contraindications

This inhaler should not be used in individuals with known hypersensitivity to soya-lecithin, soybeans, peanuts, or any other component of the inhaler. It is also contraindicated for those allergic to atropine or its derivatives.

Side Effects

Common side effects due to Salbutamol may include mild tremors and headache, which typically resolve with ongoing treatment. Rare side effects include muscle cramps, angioedema, urticaria, bronchospasm, and hypotension.

For Ipratropium Bromide, rare side effects reported include headache, influenza, chest pain, nausea, dyspnea, coughing, pharyngitis, and sinusitis.

Pregnancy & Lactation

• Ipratropium Bromide is classified as Pregnancy Category B, with no teratogenic effects observed in studies.
• Salbutamol is classified as Pregnancy Category C, with teratogenic effects noted in animal studies.

There are no well-controlled studies of Combair Inhalation Aerosol in pregnant women. Use during pregnancy should be considered only if the potential benefits justify the potential risks to the fetus. The excretion of Salbutamol and Ipratropium Bromide in human milk is unknown, so caution is advised when administering this medication to nursing mothers.

Use in Special Populations

• Ipratropium Bromide should be used with caution in patients with narrow-angle glaucoma, prostatic hypertrophy, or bladder-neck obstruction.
• Salbutamol should be used cautiously in individuals with convulsive disorders, hyperthyroidism, diabetes, or those unusually responsive to sympathomimetic amines.

Overdose Effects

Overdose symptoms are mainly associated with Salbutamol Sulphate, including anginal pain, hypertension, hypokalemia, and tachycardia. Immediate medical attention is required in case of overdose.

Therapeutic Class

Combair Inhalation Aerosol is classified as a Combined Bronchodilator.

Storage Instructions

• Do not puncture or incinerate the canister, even if it seems empty.
• Store in a cool, dry place, away from direct sunlight and heat.
• Keep out of the reach of children and away from the eyes.