This page shows what was measured, who it was measured in, and what that does not settle.
What Ipratropium Bromide does in the body
Ipratropium sits on the receptor that signal lands on and blocks it, so the muscle relaxes and secretion falls.
A nerve running to the lungs constantly signals the muscle around each airway to stay slightly tightened, and signals the glands to produce mucus. It carries a fixed electrical charge, which keeps it in the airway and out of the rest of the body — the reason it does not cause the confusion and dry eyes that atropine does. It lets go of the receptor within about a quarter of an hour, which is why it has to be taken four times a day.
Why people take it. Short-term airway relaxation, or a nasal spray for a runny nose.
What happened in people
Added during a child’s asthma attack, it cut hospital admission from 23 in 100 to 17 in 100.
✓ Reviewed first-read answer
Where this came from
A person wrote this and a reviewer approved it against this exact record. It carries no effect size.
A reviewer approved this against this record. The reviewed-claim record carrying the exact population and effect size does not exist yet.
No source is stored against this line.
The limit that matters most
Its strongest evidence is for acute childhood asthma, which the United States inhaler label does not cover.
Where it acts
Muscarinic receptors on bronchial smooth muscle and submucosal glands; nasal mucosal glands for the nasal spray
Kind of result
The kind of result is not recorded
Supervision
RNAWiki has not recorded a supervision or regulatory status for this substance.
Where each sentence above came from
A person wrote this explanation into the record, with the studies named in the path below.
A reviewer approved this sentence against this exact record and its sources.
The limit a reviewer approved as the one that matters most here.
The four opening statements run to 131 words.
Words this page uses
Four words worth knowing first
Chosen from what this page shows, with each one explained before the word it depends on.
Comparator
A comparator is whatever the treatment was measured against.
A picture of it, and where the picture fails
It is like the other runner in a race.
Where that stops being true. A race has one winner. A study can show both arms improved.
What people get wrong. Results are read without asking what the other group got. Beating nothing is not beating a treatment.
The control condition against which the experimental intervention is assessed.
Randomisation
Randomisation means chance decides who gets which treatment.
A picture of it, and where the picture fails
It is like a coin toss deciding the groups.
Where that stops being true. A coin toss is fair once. Fairness here comes from doing it for everyone.
What people get wrong. It is thought to make groups identical. It makes them similar on average, including on things nobody measured.
Allocation of participants to arms by a chance process, so that unmeasured factors are balanced in expectation.
Absolute difference
An absolute difference is how many more people in a hundred were affected.
A picture of it, and where the picture fails
It is like counting heads in two rooms of a hundred.
Where that stops being true. Heads are easy to count. Study results carry a margin of error too.
What people get wrong. It is confused with a percentage change, which can look far larger.
The arithmetic difference in event rates between arms.
Confidence interval
A confidence interval is the range the true answer is likely to sit in.
A picture of it, and where the picture fails
It is like a weather forecast giving a range rather than one number.
Where that stops being true. A forecast range covers tomorrow. This one covers what the study could resolve.
What people get wrong. The middle number is read as the answer. A range crossing zero means no change is still possible.
An interval estimate that would contain the true parameter in a stated proportion of repeated studies.
What happened in people◇Read from sources, not yet reviewed
What happened in people
Each card is one study: the exact question it asked, who was in it, and whether it showed what it set out to show.
Rate of change and cumulative change in FEV1 over five years
✗ The study did not show it
Who was studied
The Lung Health Study (Anthonisen 1994)
How many people
5887
Study design
Phase 4, randomised, three-arm, placebo-controlled, five years
Compared against
A dummy treatment
Kind of result
A number that stands in for health
What was found
The bronchodilator benefit was small, non-cumulative and reversed after discontinuation; use of ipratropium did not influence the long-term decline in FEV1. The smoking-intervention groups declined significantly more slowly than control.
Repeated elsewhere
Unreplicated
What this does not prove. A study that did not show an effect does not show that no effect exists anywhere.
The limits of this study, and where it came from
Main limit. The trial is remembered as proof that smoking cessation slows lung-function decline, which it is. It is equally a negative trial of ipratropium over five years, and that half is rarely cited.
How far it carries. This study is recorded from the curated record, not from the registry match.
Form and route. HFA inhalation aerosol (17 micrograms per actuation), preservative-free unit-dose nebuliser solution 0.02%, and nasal spray 0.03% and 0.06%
Interval reported. Not recorded in this summary
Written into the record, not signed off as a reviewed claim.
Anthonisen NR, Connett JE, Kiley JP, et al. Effects of smoking intervention and the use of an inhaled anticholinergic bronchodilator on the rate of decline o… · a recorded source, not a stored snapshot
Risk of hospital admission after emergency treatment of an acute asthma exacerbation in children
✓ The study showed what it set out to show
Who was studied
Cochrane CD000060 — anticholinergic plus beta-agonist in acute paediatric asthma
How many people
2697
Study design
Systematic review and meta-analysis of 20 randomised trials
Compared against
Not recorded for this study
Kind of result
A number that stands in for health
What was found
Risk ratio 0.73 (95% CI 0.63 to 0.85) across 15 studies and 2,497 children, graded high-quality evidence; number needed to treat 16 (95% CI 12 to 29)
Repeated elsewhere
Replicated
What this does not prove. Meeting one endpoint in one population does not carry to other goals or other people.
The limits of this study, and where it came from
Main limit. Relapse rates after discharge did not differ. Trends toward greater benefit with higher treatment intensity and greater asthma severity did not reach significance, so who benefits most within the group remains unresolved.
How far it carries. This study is recorded from the curated record, not from the registry match.
Form and route. HFA inhalation aerosol (17 micrograms per actuation), preservative-free unit-dose nebuliser solution 0.02%, and nasal spray 0.03% and 0.06%
Interval reported. 95% CI 0
Written into the record, not signed off as a reviewed claim.
Anthonisen NR, Connett JE, Kiley JP, et al. Effects of smoking intervention and the use of an inhaled anticholinergic bronchodilator on the rate of decline o… · a recorded source, not a stored snapshot
Severity of rhinorrhoea and of nasal congestion against placebo
✓ The study showed what it set out to show
Who was studied
Cochrane CD008231 — intranasal ipratropium for the common cold
How many people
2144
Study design
Systematic review and meta-analysis of 7 randomised trials
Compared against
Not recorded for this study
Kind of result
A number that stands in for health
What was found
All four studies addressing rhinorrhoea (1,959 participants) favoured ipratropium; nasal congestion showed no significant difference in four studies; side effects odds ratio 2.09 (95% CI 1.40 to 3.11)
Repeated elsewhere
Partially Replicated
What this does not prove. Meeting one endpoint in one population does not carry to other goals or other people.
The limits of this study, and where it came from
Main limit. Overall risk of bias across included studies was judged moderate, and the review calls for larger high-quality trials. Nasal dryness, blood-tinged mucus and epistaxis were the common side effects.
How far it carries. This study is recorded from the curated record, not from the registry match.
Form and route. HFA inhalation aerosol (17 micrograms per actuation), preservative-free unit-dose nebuliser solution 0.02%, and nasal spray 0.03% and 0.06%
Interval reported. 95% CI 1
Written into the record, not signed off as a reviewed claim.
Anthonisen NR, Connett JE, Kiley JP, et al. Effects of smoking intervention and the use of an inhaled anticholinergic bronchodilator on the rate of decline o… · a recorded source, not a stored snapshot
Vincken 2002 — ipratropium against tiotropium, two identical one-year trials
How many people
535
Study design
Phase 3, randomised, double-blind, double-dummy, active comparator, one year
Compared against
Not recorded for this study
Kind of result
A number that stands in for health
What was found
Trough FEV1 -0.03±0.02 L on ipratropium against +0.12±0.01 L on tiotropium, P<0.001; 24% more exacerbations on ipratropium, P<0.01
Repeated elsewhere
Replicated
What this does not prove. A study that did not show an effect does not show that no effect exists anywhere.
The limits of this study, and where it came from
Main limit. No limitation is recorded for this study.
How far it carries. This study is recorded from the curated record, not from the registry match.
Form and route. HFA inhalation aerosol (17 micrograms per actuation), preservative-free unit-dose nebuliser solution 0.02%, and nasal spray 0.03% and 0.06%
Interval reported. Not recorded in this summary
Written into the record, not signed off as a reviewed claim.
Anthonisen NR, Connett JE, Kiley JP, et al. Effects of smoking intervention and the use of an inhaled anticholinergic bronchodilator on the rate of decline o… · a recorded source, not a stored snapshot
RNAWiki holds 4 written-up human studies for this substance, each with the question it asked.
How we know it
Each card names the study, the number of people and what the study set out to measure.
What this does not prove
These summaries were written by a person and have not been signed off as reviewed claims.
Why it matters
A study that failed is as informative as one that worked, and both are here.
What we still do not know
No reviewed claim exists, so no exact population, effect size or interval is published yet.
What it changes in the body◇Read from sources, not yet reviewed
The path through the body
From what a person takes to what changes. A solid line is a step measured in people. A dashed line is a step nobody has measured that way.
Start
Ipratropium Bromide
What a person takes: HFA inhalation aerosol (17 micrograms per actuation), preservative-free unit-dose nebuliser solution 0.02%, and nasal spray 0.03% and 0.06%.
The measurement behind this step
Four times daily for maintenance in COPD. The nebuliser solution is the form that matters in acute care: it needs no inspiratory effort, no breath-hold and no coordination, which is what makes it usable in a child mid-attack or an adult too breathless to use an inhaler. It is routinely mixed with salbutamol in the same nebuliser chamber, and fixed combinations of the two exist for that reason.
Getting in
Given as a mist, a puff or a nasal spray
It exists in more forms than almost anything else here: a nebuliser solution driven by a compressor, a pressurised inhaler, and a nasal spray for a running nose.
──Measured in people. Written by a person from the study named beside the step. Not signed off as a reviewed claim.
The measurement behind this step
Ipratropium bromide as a preservative-free 0.02% unit-dose nebuliser solution, a 17 microgram per actuation HFA inhalation aerosol, and 0.03% and 0.06% nasal solutions. The nebuliser route is why it dominates emergency and inpatient use: it needs no inspiratory effort and no coordination from a breathless patient.
Anthonisen NR, Connett JE, Kiley JP, et al. Effects of smoking intervention and the use of an inhaled anticholinergic bronchodilator on the rate of decline o… · a recorded source, not a stored snapshot
It is atropine with one extra chemical group that gives it a permanent electrical charge. That single change stops it crossing into the brain, which is the difference between a bronchodilator and a deliriant.
╌╌Described, with no measurement named. No measurement is named for this step, so it is drawn as an unconfirmed link.
The measurement behind this step
N-isopropyl noratropine quaternised at the tropane nitrogen. The fixed positive charge limits passive membrane permeation and blood-brain barrier penetration, so systemic absorption from the airway and from swallowed drug is minimal and central antimuscarinic effects do not occur at therapeutic doses.
Anthonisen NR, Connett JE, Kiley JP, et al. Effects of smoking intervention and the use of an inhaled anticholinergic bronchodilator on the rate of decline o… · a recorded source, not a stored snapshot
It blocks the acetylcholine receptor on airway muscle
The nerve releases acetylcholine, which normally lands on a receptor and makes the muscle squeeze and the glands secrete. Ipratropium occupies that receptor instead.
╌╌Described, with no measurement named. No measurement is named for this step, so it is drawn as an unconfirmed link.
The measurement behind this step
The label describes ipratropium as inhibiting vagally-mediated reflexes by antagonising acetylcholine at the neuromuscular junctions of the lung, and states that, based on animal studies, anticholinergics prevent the rise in intracellular calcium caused by acetylcholine interacting with muscarinic receptors on bronchial smooth muscle.
Anthonisen NR, Connett JE, Kiley JP, et al. Effects of smoking intervention and the use of an inhaled anticholinergic bronchodilator on the rate of decline o… · a recorded source, not a stored snapshot
It does not stay on the receptor. Within a quarter of an hour most of it has let go, which is why it is taken four times a day rather than once.
──Measured in people. Written by a person from the study named beside the step. Not signed off as a reviewed claim.
The measurement behind this step
Published dissociation half-lives from human receptors: 0.26 hours at M3, 0.11 hours at M1 and 0.035 hours at M2, against 34.7, 14.6 and 3.6 hours respectively for tiotropium in the same experiments. Duration of bronchoprotection in dogs was correspondingly shorter than for an equipotent dose of tiotropium.
Anthonisen NR, Connett JE, Kiley JP, et al. Effects of smoking intervention and the use of an inhaled anticholinergic bronchodilator on the rate of decline o… · a recorded source, not a stored snapshot
Bronchodilation begins within minutes and lasts a few hours. In the nose the same block dries the watery running that a cold produces.
╌╌Described, with no measurement named. No measurement is named for this step, so it is drawn as an unconfirmed link.
The measurement behind this step
Onset is slower and peak effect weaker than a short-acting beta-2 agonist, which is why the two are combined rather than substituted. The nasal effect is on the seromucous glands, which is why the label says the spray relieves rhinorrhoea and explicitly not congestion or sneezing.
Anthonisen NR, Connett JE, Kiley JP, et al. Effects of smoking intervention and the use of an inhaled anticholinergic bronchodilator on the rate of decline o… · a recorded source, not a stored snapshot
Five years of the drug in nearly six thousand smokers produced a small lung-function gain that never built up and vanished when the drug stopped. The thing that changed the trajectory in that trial was quitting smoking.
╌╌Described, with no measurement named. No measurement is named for this step, so it is drawn as an unconfirmed link.
The measurement behind this step
The Lung Health Study reports the bronchodilator benefit as small, non-cumulative and reversed on discontinuation, with no influence on the long-term rate of FEV1 decline. The smoking-cessation arms showed a significantly slower decline, concentrated in the first year and largest in sustained quitters.
Anthonisen NR, Connett JE, Kiley JP, et al. Effects of smoking intervention and the use of an inhaled anticholinergic bronchodilator on the rate of decline o… · a recorded source, not a stored snapshot
No suggested links are held for this record, so nothing is hidden from this path.
What we know
The record describes 6 steps from taking it to an effect in a person.
How we know it
Each step names the study behind it in the technical detail beside it.
What this does not prove
A change inside the body is a reason to look. It is not a result in a person.
Why it matters
A reader can see exactly where the chain stops being measured in people.
What we still do not know
No reviewed claim binds any of these steps to a named population.
What is missing or unclear◇Read from sources, not yet reviewed
Were people like you studied?
RNAWiki cannot tell whether a study fits you. It can show who was in it, and where the result stops carrying.
Who was studied
People similar to this profile were included.
People with chronic obstructive pulmonary disease, as maintenance treatment or nebulised in hospital; children and adults in the emergency department during an asthma attack, mixed with salbutamol; and people with a persistently running nose from a cold or hay fever.
Who is missing from the studies
Which groups were under-represented in the studies has not been recorded for this substance. Pregnancy, breastfeeding, children, older adults, and people with liver or kidney conditions are commonly excluded from trials; nothing here says whether they were.
What the label states about particular groups
On pediatric, the label states: “Safety and effectiveness in the pediatric population have not been established.”
US prescribing information · 170e98ef-5560-4068-be7d-e649068eb884 · read 2026-08-30
On older people, the label states: “In the pivotal 12-week study, both ATROVENT HFA and ATROVENT CFC formulations were equally effective in patients over 65 years of age and under 65 years of age.”
US prescribing information · 170e98ef-5560-4068-be7d-e649068eb884 · read 2026-08-30
On people who are pregnant, the label states: “Risk Summary Ipratropium is negligibly absorbed systemically following oral inhalation; therefore, maternal use is not expected to result in fetal exposure to the drug [ see Clinical Pharmacology (12.3) ].”
US prescribing information · 170e98ef-5560-4068-be7d-e649068eb884 · read 2026-08-30
On people who are breastfeeding, the label states: “Risk Summary There are no data on the presence of ipratropium in either human or animal milk, the effects on the breastfed infant, or the effects on milk production.”
US prescribing information · 170e98ef-5560-4068-be7d-e649068eb884 · read 2026-08-30
Where the result stopped carrying
Five years of treatment in 5,887 people produced no change in the rate of lung-function decline
Trough lung function fell over a year on ipratropium while rising on the once-daily successor in the same trials
The 2008 class meta-analysis put a cardiovascular signal on ipratropium that has been overtaken rather than directly refuted
The nasal spray doubles the odds of a side effect and does nothing for the blocked nose most users want relieved
This is a scope explorer, not a diagnosis engine.
It shows who was studied so you can see whether people similar to you were included.
RNAWiki cannot tell whether a study fits you. It can show who was in it.
What it would be like to take◇Read from sources, not yet reviewed
Why it might seem to do nothing
A real effect and a noticed effect are different things. These are the recorded reasons the two come apart.
It was studied in different people
The people in the studies were not much like the reader.
On this record: Which groups were under-represented in the studies has not been recorded for this substance. Pregnancy, breastfeeding, children, older adults, and people with liver or kidney conditions are commonly excluded from trials; nothing here says whether they were.
The evidence may simply be wrong
Small early studies often do not hold up.
On this record: RNAWiki has not yet published a reviewed conclusion for this use.
Other reasons RNAWiki checked and found nothing for (11)
It was studied for a different goal
The studies measured something else entirely. Nothing in this record points to this reason.
A different form was studied
The studied form is not the form on the shelf. Nothing in this record points to this reason.
There was nothing to correct
Where a level is already normal, topping it up may change nothing. Nothing in this record points to this reason.
Something else had to happen too
In the studies it was paired with training, a diet or another treatment. Nothing in this record points to this reason.
The change is too small to feel
A real change can still sit below what a person notices. Nothing in this record points to this reason.
Day-to-day swing hides it
Sleep, food, stress and time of day move most numbers more than this would. Nothing in this record points to this reason.
Not enough time yet
The studies ran longer than the person has waited. Nothing in this record points to this reason.
It was not taken as studied
Missed days change the result, and studies count them. Nothing in this record points to this reason.
Something else changed at the same time
Two changes at once cannot be told apart afterwards. Nothing in this record points to this reason.
The product may not be what it says
Contents of a sold product are not always what the label states. Nothing in this record points to this reason.
No recorded reason
RNAWiki has nothing stored that would explain it. Nothing in this record points to this reason.
None of these is a reason to take more. Taking more is not a step this page ever suggests.
What it would be like to take◇Read from sources, not yet reviewed
What taking it involves
The recorded facts about getting hold of it and using it. Nothing here is a suggestion about what you should do.
How it is supplied
Prescription only
❝ Quoted from a source
Where this came from
Copied from a source RNAWiki stored, with the source named.
Read from the recorded approval status.
No source is stored against this line.
Form and route
HFA inhalation aerosol (17 micrograms per actuation), preservative-free unit-dose nebuliser solution 0.02%, and nasal spray 0.03% and 0.06%
✎ Source-linked record
Where this came from
A person wrote this into the record with the study named beside it. No reviewer has signed it off.
The form and route recorded on this substance.
No source is stored against this line.
Who oversees it
RNAWiki has not recorded a supervision or regulatory status for this substance.
❝ Quoted from a source
Where this came from
Copied from a source RNAWiki stored, with the source named.
No register row and no identity class settled the question.
No source is stored against this line.
What is in the pack
Four times daily for maintenance in COPD.
✎ Source-linked record
Where this came from
A person wrote this into the record with the study named beside it. No reviewer has signed it off.
Recorded notes on how this is sold. The rest of the recorded wording: The nebuliser solution is the form that matters in acute care: it needs no inspiratory effort, no breath-hold and no coordination, which is what makes it usable in a child mid-attack or an adult too breathless to use an inhaler. It is routinely mixed with salbutamol in the same nebuliser chamber, and fixed combinations of the two exist for that reason.
No source is stored against this line.
Where it is registered
Regulatory records are listed in the technical disclosure at the foot of this page.
# Counted from records
Where this came from
A count of rows RNAWiki holds. It describes our records, not your body.
Register entries are stored per jurisdiction and shown with their dates.
No source is stored against this line.
Why people stop
Not recorded.
∅ Nothing recorded
Where this came from
RNAWiki holds nothing here and says so rather than guessing.
No record of why people stopped taking it is stored for this substance.
No source is stored against this line.
What it would be like to take◇Read from sources, not yet reviewed
What can go wrong
Sorted by where each line came from. A regulator's label and a report somebody sent in are not the same kind of fact.
·Worth asking a clinician aboutWritten into the record from the studies named on this page
Not indicated for the initial treatment of acute episodes of bronchospasm where rescue therapy is required for rapid response. Hypersensitivity reactions including urticaria, angioedema, rash, bronchospasm, anaphylaxis and oropharyngeal oedema require immediate discontinuation. Paradoxical bronchospasm can occur. Ocular effects require caution in narrow-angle glaucoma, with patients instructed to seek advice immediately if eye pain, blurred vision or visual haloes develop — a risk raised by nebulised mist escaping around a loose face mask. Urinary retention may worsen in prostatic hyperplasia or bladder-neck obstruction. The most common adverse reactions above 5% in the 12-week placebo-controlled trials were bronchitis, COPD exacerbation, dyspnoea and headache.
Nobody counted how many people took this and were fine, so this cannot be turned into a rate.
Where this came from
Anthonisen NR, Connett JE, Kiley JP, et al. Effects of smoking intervention and the use of an inhaled anticholinergic bronchodilator on the rate of decline o… · a recorded source, not a stored snapshot
Over a long time. No completed tested study window is recorded, so long-term effects are not established by the registry record.
Groups the studies covered thinly. Which groups were under-represented in the studies has not been recorded for this substance. Pregnancy, breastfeeding, children, older adults, and people with liver or kidney conditions are commonly excluded from trials; nothing here says whether they were.
What is missing or unclear◇Read from sources, not yet reviewed
Does the exact form matter?
Evidence belongs to the exact thing that was tested. A different salt, a different mixture or a different preparation is a different question.
The form that was studied
HFA inhalation aerosol (17 micrograms per actuation), preservative-free unit-dose nebuliser solution 0.02%, and nasal spray 0.03% and 0.06%
✎ Source-linked record
Where this came from
A person wrote this into the record with the study named beside it. No reviewer has signed it off.
The form used in the studies cited on this page.
No source is stored against this line.
What is sold
A recorded note compares this form with the others that are sold. It is kept below, word for word.
§ A fixed RNAWiki sentence
Where this came from
Wording RNAWiki always uses, not a finding about this substance.
The recorded note, unchanged: The nebuliser solution is the form that matters in acute care: it needs no inspiratory effort, no breath-hold and no coordination, which is what makes it usable in a child mid-attack or an adult too breathless to use an inhaler. It is routinely mixed with salbutamol in the same nebuliser chamber, and fixed combinations of the two exist for that reason.
No source is stored against this line.
What is recorded as being sold
Recorded price in US: 0.35477–0.81037 USD per one millilitre, across 12 priced products whose strengths and pack forms differ, as of 2026-08-26, paid by retail pharmacies buying the product, as surveyed by the Centers for Medicare & Medicaid Services. It is not a list price, an insurance price, or what anyone pays at a counter..
Recorded source · 2026-08-26 · read 2026-08-28
Evidence carries across two names for one substance. It does not carry across a salt, a mirror form or a mixture.
What it would be like to take◇Read from sources, not yet reviewed
What you could measure
This one is decided with a clinician, so this section holds questions to ask rather than a plan to run.
RNAWiki could not confidently classify this substance, so no self-experiment plan is offered.
Questions worth asking
Which of the trials of Ipratropium Bromide studied people like me?
What was measured, and for how long?
Was the result a laboratory value or a health outcome?
What would we watch for, and when would we stop?
Tracking can show whether something changed for you. It cannot show what caused it.
RNAWiki records evidence. It does not say whether this substance is right for you.
What is missing or unclear◇Read from sources, not yet reviewed
Claims that go past the evidence
Things said about this substance that sound reasonable, and the exact step that is missing between the evidence and the claim.
✗Goes past the evidence
That an inhaled anticholinergic slows the progression of chronic obstructive pulmonary disease — a five-year randomised trial says it does not
Why it sounds right. It follows from something real on this page: a body step, an animal result or a related finding.
The missing step. Nobody measured this in people for this use, or the study that did measure it did not show it.
What would change this
A study in people, for this exact use, measuring this exact thing, that a reviewer signs off.
RNAWiki has not yet published a reviewed conclusion for this use.
✗Goes past the evidence
That the drug’s label indication marks where its evidence is strongest, when the strongest evidence is in a disease absent from the indication
Why it sounds right. It follows from something real on this page: a body step, an animal result or a related finding.
The missing step. Nobody measured this in people for this use, or the study that did measure it did not show it.
What would change this
A study in people, for this exact use, measuring this exact thing, that a reviewer signs off.
RNAWiki has not yet published a reviewed conclusion for this use.
✗Goes past the evidence
That the nasal spray treats a cold, when it treats one symptom of a cold and explicitly not congestion or sneezing
Why it sounds right. It follows from something real on this page: a body step, an animal result or a related finding.
The missing step. Nobody measured this in people for this use, or the study that did measure it did not show it.
What would change this
A study in people, for this exact use, measuring this exact thing, that a reviewer signs off.
RNAWiki has not yet published a reviewed conclusion for this use.
✗Goes past the evidence
That the large tiotropium safety trials settled the 2008 cardiovascular question for ipratropium, which they did not study
Why it sounds right. It follows from something real on this page: a body step, an animal result or a related finding.
The missing step. Nobody measured this in people for this use, or the study that did measure it did not show it.
What would change this
A study in people, for this exact use, measuring this exact thing, that a reviewer signs off.
RNAWiki has not yet published a reviewed conclusion for this use.
What is missing or unclear◇Read from sources, not yet reviewed
What nobody knows yet
Open questions, each with why it is open and what would close it.
Missing populations
Which groups were under-represented in the studies has not been recorded.
Why it matters. Recorded by the evidence model as a gap on this record.
What would answer it
A study that measures it, and a reviewer to sign it off.
Last checked 2026-09-04. Searched: The sources listed in the receipts at the foot of this page.
Missing long-term data
No completed tested study window is recorded.
Why it matters. Recorded by the evidence model as a gap on this record.
What would answer it
A study that measures it, and a reviewer to sign it off.
Last checked 2026-09-04. Searched: The sources listed in the receipts at the foot of this page.
No reviewed conclusion
RNAWiki has not yet published a reviewed conclusion for this use.
Why it matters. Recorded by the evidence model as a gap on this record.
What would answer it
A study that measures it, and a reviewer to sign it off.
Last checked 2026-09-04. Searched: The sources listed in the receipts at the foot of this page.
Missing interaction studies
No interaction was found in the registers checked. Not finding one is not the same as showing there is none.
Why it matters. Recorded by the evidence model as a gap on this record.
What would answer it
A study that measures it, and a reviewer to sign it off.
Last checked 2026-09-04. Searched: The sources listed in the receipts at the foot of this page.
Formulation uncertainty
Several salts, forms or products of Ipratropium Bromide are recorded. Results from one form may not transfer to another.
Why it matters. Recorded by the evidence model as a gap on this record.
What would answer it
A study that measures it, and a reviewer to sign it off.
Last checked 2026-09-04. Searched: The sources listed in the receipts at the foot of this page.
Mechanism not reviewed
No reviewed mechanism story exists for this substance.
Why it matters. Recorded by the evidence model as a gap on this record.
What would answer it
A study that measures it, and a reviewer to sign it off.
Last checked 2026-09-04. Searched: The sources listed in the receipts at the foot of this page.
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The Lung Health Study: five years, 5,887 smokers, and the benefit evaporated
In plain words
The largest trial ipratropium has ever been in gave it three times a day for five years to smokers with early lung disease. It produced a small improvement in lung function that never accumulated, and disappeared as soon as the drug was stopped. What did slow the decline was quitting smoking.
What was measured
Rate of change and cumulative change in FEV1 over five years, ipratropium against placebo on a background of smoking intervention
Effect estimate
No reviewed effect estimate exists for this record.
Limits
This entry records a failure.
From the source
The Lung Health Study randomised 5,887 smokers aged 35 to 60 with spirometric signs of early chronic obstructive pulmonary disease, with equal probability, to smoking intervention plus ipratropium two puffs three times daily, smoking intervention plus placebo, or no intervention. The main outcome measures were rate of change and cumulative change in FEV1 over five years. Both smoking-intervention groups declined significantly more slowly than the control group, with most of the difference occurring in the first year and attributable to cessation, and the largest benefit in those who stayed abstinent. The authors record that the small non-cumulative benefit associated with the active bronchodilator vanished after it was discontinued at the end of the study, and that use of the bronchodilator did not influence the long-term decline of FEV1.
Source
Anthonisen NR, Connett JE, Kiley JP, et al. JAMA 1994;272:1497-1505 (The Lung Health Study)
Role in the trial
Not matched to a registered study
Identity check
no open identity hold
Audit mark
verified
Review state
Written into the record, not signed off as a reviewed claim
In a child’s asthma attack it takes admissions from 23 in 100 to 17 in 100
In plain words
This is the strongest evidence ipratropium has, and it is for something its label does not mention. Adding it to a salbutamol nebuliser during a child’s asthma attack reduces the chance of being admitted to hospital by about a quarter.
What was measured
Risk of hospital admission after emergency-department treatment of an acute asthma exacerbation in children
Effect estimate
No reviewed effect estimate exists for this record.
Limits
See the technical detail.
From the source
A Cochrane review of 20 trials generating 24 comparisons in 2,697 randomised children aged one to 18 with predominantly moderate or severe exacerbations found that adding an inhaled anticholinergic to a short-acting beta-2 agonist reduced the risk of hospital admission, risk ratio 0.73 (95% CI 0.63 to 0.85; 15 studies, 2,497 children, graded high-quality evidence). Twenty-three of 100 children given beta-agonist alone were admitted, against 17 (95% CI 15 to 20) of 100 given the combination — a number needed to treat of 16 (95% CI 12 to 29). Lung function, clinical score at 120 minutes, oxygen saturation at 60 minutes and the need for repeat bronchodilators before discharge all favoured the combination. Relapse rates did not differ. Nausea and tremor were reported less often on the combination than on beta-agonist alone.
Written into the record, not signed off as a reviewed claim
Its best evidence and its label indication are for different diseases
In plain words
The United States inhaler label says maintenance treatment of chronic obstructive pulmonary disease, and adds that the drug is not for the initial treatment of an acute attack. The high-quality evidence is for the initial treatment of an acute asthma attack in children.
What was measured
That the label indication describes where the drug is best supported — here it describes a different disease from the one the strongest randomised evidence covers
Effect estimate
No reviewed effect estimate exists for this record.
Limits
See the technical detail.
From the source
The ATROVENT HFA prescribing information indicates the product as a bronchodilator for maintenance treatment of bronchospasm associated with COPD, and Warnings and Precautions 5.1 states it is not indicated for the initial treatment of acute episodes of bronchospasm where rescue therapy is required for rapid response. Asthma does not appear in the indication. Meanwhile the Cochrane review graded as high-quality evidence covers exactly that setting — nebulised ipratropium, typically three doses of 250 micrograms or two of 500 micrograms over 30 to 90 minutes, added to a beta-agonist during a paediatric asthma exacerbation. Emergency guidelines worldwide recommend it there. This is a legitimate off-label practice supported by better evidence than most on-label ones, and the mismatch is a fact about how labels are written, not a criticism of the practice.
Written into the record, not signed off as a reviewed claim
The nasal spray dries a running nose and does nothing for a blocked one
In plain words
Seven trials in 2,144 people found the nasal spray consistently reduced a running nose during a cold. It had no effect at all on congestion, which is the symptom most people actually want treated, and it doubled the rate of side effects.
What was measured
Subjective severity of rhinorrhoea and of nasal congestion, and side-effect rate, against placebo
Effect estimate
No reviewed effect estimate exists for this record.
Limits
See the technical detail.
From the source
A Cochrane review of seven randomised trials with 2,144 participants found that four studies in 1,959 participants addressing subjective change in severity of rhinorrhoea all reported statistically significant changes favouring intranasal ipratropium. Four studies reported nasal congestion and found no significant difference. Two studies found a positive response for global assessment of overall improvement. Side effects were more frequent with ipratropium, odds ratio 2.09 (95% CI 1.40 to 3.11), commonly nasal dryness, blood-tinged mucus and epistaxis. Overall risk of bias across the included studies was judged moderate. The United States nasal label states the same limitation in its own words: the spray does not relieve nasal congestion or sneezing.
Written into the record, not signed off as a reviewed claim
Beaten head to head by its own successor
In plain words
Two identical year-long trials compared ipratropium four times a day with tiotropium once a day. Lung function rose on tiotropium and fell on ipratropium, and flare-ups were about a quarter less frequent on the newer drug.
What was measured
Trough FEV1 and exacerbation rate at one year, ipratropium four times daily against tiotropium once daily
Effect estimate
No reviewed effect estimate exists for this record.
Limits
This entry records a failure.
From the source
Two identical one-year randomised, double-blind, double-dummy trials compared tiotropium 18 micrograms once daily (n=356) with ipratropium 40 micrograms four times daily (n=179) in patients with screening FEV1 around 40% predicted. Trough FEV1 at one year improved by 0.12±0.01 L on tiotropium and declined by 0.03±0.02 L on ipratropium (P<0.001). Peak expiratory flow, rescue salbutamol use, Transition Dyspnea Index focal score and St George’s Respiratory Questionnaire total and impact scores all favoured tiotropium (P<0.01). Exacerbations fell by 24% (P<0.01), with longer time to first exacerbation (P<0.01) and to first hospitalisation for exacerbation (P<0.05). The mechanistic reason is in the receptor kinetics: 0.26 hours at M3 against 34.7.
Written into the record, not signed off as a reviewed claim
It was inside the 2008 cardiovascular meta-analysis that the class outgrew
In plain words
A pooled analysis in 2008 reported that inhaled anticholinergics — ipratropium and tiotropium together — raised the risk of heart attack, cardiovascular death or stroke by about sixty per cent. The two very large trials that followed, both of tiotropium, did not find it.
What was measured
That the large tiotropium trials cleared ipratropium too — a class-level conclusion resting on trials of a different molecule, which is the same reasoning that produced the original alarm
Effect estimate
No reviewed effect estimate exists for this record.
Limits
See the technical detail.
From the source
Singh and colleagues pooled 17 randomised trials of inhaled anticholinergics enrolling 13,645 patients with COPD. The composite of cardiovascular death, myocardial infarction or stroke occurred in 134 of 6,984 (1.9%) against 83 of 6,661 (1.2%) on control, relative risk 1.60 (95% CI 1.22 to 2.10, P<0.001, I2=0%), with all-cause mortality relative risk 1.29 (1.00 to 1.65, P=0.05). UPLIFT (5,993 patients, four years) and TIOSPIR (17,135 patients, mean 2.3 years) both reported similar cardiovascular event rates between arms. Those two trials studied tiotropium, not ipratropium, so strictly the meta-analytic signal for ipratropium itself has never been directly refuted — it has been overtaken. The class inference that raised the alarm and the class inference that settled it have the same weakness in opposite directions.
Written into the record, not signed off as a reviewed claim
A hundredfold price gap for the same receptor
In plain words
The CMS acquisition survey lists sixty generic ipratropium products at about eleven cents a millilitre. The once-daily antimuscarinics that replaced it are listed at ten to twelve dollars per dose, and are brand-only.
What was measured
Median pharmacy acquisition cost per listed unit, ipratropium against the branded long-acting antimuscarinics
Effect estimate
No reviewed effect estimate exists for this record.
Limits
See the technical detail.
From the source
The CMS National Average Drug Acquisition Cost file effective 19 August 2026 lists ipratropium inhalation solution at a median US$0.1089 per millilitre across 60 generic presentations, tiotropium at US$11.73 per unit across 7 brand presentations and umeclidinium at US$10.28 per unit across 3. NADAC is what a United States pharmacy pays to acquire the product, not what a patient is charged and not a cost of manufacture. The gap is not explained by the molecules, which are close chemical relatives acting on the same receptor family; it is explained by patent status and by the fact that a nebuliser solution requires no proprietary device while a dry-powder or soft-mist product does.
Source
CMS National Average Drug Acquisition Cost (NADAC) 2026 file, prices effective 19 August 2026
Role in the trial
Not matched to a registered study
Identity check
no open identity hold
Audit mark
verified
Review state
Written into the record, not signed off as a reviewed claim
Where else this substance is registered
FDA substance identifier (UNII)
J697UZ2A9J
CAS registry number
60205-81-4
PubChem compound
657309
RxNorm concept
1309404
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A quaternary derivative of atropine that blocks muscarinic receptors on airway muscle and falls off them within about fifteen minutes, so it is dosed four times a day; over five years in 5,887 smokers it produced a small non-cumulative gain in lung function that vanished the moment it was stopped, and its strongest evidence is somewhere else entirely — added to salbutamol during a child’s asthma attack it cut hospital admission from 23 in 100 to 17 in 100 across 15 trials in 2,497 children.
Recorded evidence blocks (7)
Q1
On the Ipratropium Bromide label: indicated for what?
"ATROVENT HFA Inhalation Aerosol is indicated as a bronchodilator for maintenance treatment of bronchospasm associated with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema. ATROVENT HFA is an anticholinergic indicated for the maintenance treatment of bronchospasm associated with…": indications and usage on Ipratropium Bromide's label. DailyMed label · 170e98ef-5560-4068-be7d-e649068eb884 · 2025-11-05
Q2
59 registered trials of Ipratropium Bromide — at which phases?
Registered studies posting no result
39 of 59
59 registered studies of Ipratropium Bromide: 16 phase4, 12 phase2, 11 phase3, 10 na, 7 na or unstated, 4 phase1, 1 early phase1. CLINICALTRIALS_SNAPSHOT · 2026-09-01
818 with a PubMed record
Show the evidence
phase4
16
phase2
12
phase3
11
na
10
na or unstated
7
phase1
4
5 more recorded rows
early phase1
1
completed
49
unknown
5
terminated
3
not yet recruiting
2
recorded 2026-09-01 · last checked 2026-09-04
Q3
2 of Ipratropium Bromide's trials stopped: accrual/recruitment, funding/business?
ClinicalTrials.gov — US Government work · mixed register set; per-register licences in docs/specs/corpus-20k-sources.md · openFDA / DailyMed — US Government work
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