Levosulbutamol 50 mcg + Ipratropium 20 mcgDuodrip

How Duodrip works

This is a combination, and each component opens the airway by a different route. Ipratropium blocks the muscarinic receptors through which the vagus nerve keeps a constant mild tone on the airway muscle. Releasing that tone widens the airway by a route entirely separate from beta-2 stimulation, which is why combining the two opens the airway further than either alone. The anticholinergic contribution is proportionally larger in COPD than in asthma. Levosalbutamol stimulates beta-2 receptors on the muscle wrapped around the airways. That muscle relaxes, the airway opens and the wheeze eases within minutes. This is rescue therapy -- it works fast and wears off in a few hours, so it relieves an attack but does nothing about the inflammation that caused it. Levosalbutamol is the single active isomer rather than the racemic mixture. The inactive isomer in ordinary salbutamol contributes little bronchodilation but does contribute to tremor and a racing pulse, which is why the pure form is often chosen for children and for patients who cannot tolerate salbutamol. Two mechanisms together achieve more than pushing either one higher. This is a metered dose inhaler. Each actuation delivers an exact dose directly to the airway within seconds, and the whole thing fits in a pocket. It does require the press and the breath to be coordinated, which is what a spacer is for -- with one fitted, an inhaler works well even for young children.