Duoneb (ipratropium bromide/albuterol sulfate) / Viatris - LARVOL DELTA

THE SILENT STORM: FROM RSV TO ARDS (SCCM 2025) - "She was treated with Dexamethasone, Magnesium, and Duonebs, but left against medical advice. With the RSV vaccine recent approval for adults aged ≥60, it is reasonable to add RSV to the differential diagnosis. Just as we have learned to recognize COVID-19 rapidly, we should apply similar strategies for identifying RSV cases."

Acute Respiratory Distress Syndrome • Cardiovascular • Cough • Infectious Disease • Novel Coronavirus Disease • Psychiatry • Respiratory Diseases • Respiratory Syncytial Virus Infections

CASTING LIGHT ON THE UNFORESEEN: NEBULIZED IPRATROPIUM'S RARE TWIST--A CASE REPORT OF URINARY RETENTION IN A PATIENT WITHOUT BENIGN PROSTATIC HYPERPLASIA (CHEST 2024) - "INTRODUCTION: Acute urinary retention is a medical emergency which can be associated with serious complications. Clinicians should be vigilant, especially when patients are on scheduled DuoNeb, periodically reassessing the necessity for such medication to mitigate potential adverse effects. This underscores the importance of individualized risk assessment and medication management to optimize patient safety and outcomes."

Case report • Clinical • Asthma • Benign Prostatic Hyperplasia • Chronic Obstructive Pulmonary Disease • Immunology • Respiratory Diseases

Vocal Cord Spasm Causing Respiratory Failure: An Underdiagnosed Differential (ATS 2024) - "She was started on albuterol, inhaled corticosteroids, Flonase, and Ativan, and was admitted with a diagnosis of acute hypoxic respiratory failure in the setting of asthma exacerbation versus vocal cord dysfunction for closer monitoring of the airway...Home medications of codeine, gabapentin, prednisone, guaifenesin, PPI, DuoNebs, and zithromax were continued...These patients should be referred to ENT, to avoid delays in work-up and to initiate appropriate treatment. Management usually focuses on optimal treatment of underlying triggers, therapeutic breathing maneuvers, and vocal cord relaxation techniques."

Asthma • Chronic Cough • Cough • Dysphonia • Gastroesophageal Reflux Disease • Immunology • Infectious Disease • Influenza • Mood Disorders • Novel Coronavirus Disease • Otorhinolaryngology • Psychiatry • Pulmonary Disease • Respiratory Diseases • Respiratory Syncytial Virus Infections • Rheumatoid Arthritis

Cause and Effect: Long Covid and High-grade B-cell Lymphoma (ATS 2024) - "He was treated with IV steroids, Duonebs and antibiotics...Hospitalization may also be related to new cancer diagnosis due to extensive work-up and imaging conducted while inpatient. Links between long COVID and cancer have been found, however further studies are needed to provide definitive answers."

Cardiovascular • Chronic Kidney Disease • CNS Disorders • Endocrine Disorders • Hematological Malignancies • Lymphoma • Metabolic Disorders • Nephrology • Non-Hodgkin’s Lymphoma • Novel Coronavirus Disease • Oncology • Renal Disease • Respiratory Diseases • TNFA

Efficacy Of Ipratropium Bromide/Albuterol Compared To Home Metered-Dose Inhalers For Inpatient Management Of Asthmatics (AAAAI 2024) - "Given extensive use of ipratropium bromide/albuterol nebulizer (Duoneb), this study compares clinical outcomes between Duoneb and home Metered Dose Inhalers (MDIs) regimen... Resumption of home MDIs is associated with shorter hospital length of stay and early treatments may provide better clinical outcomes for inpatient management in patients with asthma."

Clinical • Asthma • CNS Disorders • Immunology • Infectious Disease • Inflammation • Novel Coronavirus Disease • Pneumonia • Pulmonary Disease • Respiratory Diseases • Septic Shock

ATYPICAL PRESENTATION OF ELIZABETHKINGIA IN COPD PATIENTS (CHEST 2023) - "She was treated with 2 rounds of DuoNeb en route but was still presenting with clear signs of increased work of breathing via accessory muscle use...She was transitioned from azithromycin and ceftriaxone to piperacillin/tazobactam, vancomycin, and metronidazole per Pulmonary and ID recommendations. Urine cultures resulted in Enterococcus being sensitive to ampicillin, and blood cultures showed gram-negative rod bacteria but, given her cefepime-related encephalopathy earlier in the admission, the patient received piperacillin-tazobactam...Finally, about 7 days later, blood cultures showed growth of Elizabethkingia, and given sensitivities, it was determined to ultimately treat the patient with trimethoprim/sulfamethoxazole, due to her multiple antibiotic allergies... In the setting of severely ill patients, especially those with physiological changes secondary to chronic obstructive pulmonary disease, it is important to consider typically benign infections as the source..."

Clinical • Allergy • Cardiovascular • Chronic Obstructive Pulmonary Disease • CNS Disorders • Immunology • Infectious Disease • Musculoskeletal Diseases • Orthopedics • Pulmonary Disease • Pulmonary Embolism • Respiratory Diseases • Septic Shock

Blastomycosis Induced Circumferential Tracheobronchial Thickening: A Case Report (ATS 2023) - "He was started on multiple medications including multiple courses of prednisone. Medications including Advair 500/50 twice a day showed partial improvement, Montelukast which did not seem to help...DuoNeb and albuterol inhaler seems to help for short time...Nucala for 6 months with no help, discontinued. Dupixent was started 2 months ago with minimal improvement, discontinued...The patient was treated with itraconazole and has shown significant clinical improvement...He was started on multiple medications including multiple courses of prednisone. Medications including Advair 500/50 twice a day showed partial improvement, Montelukast which did not seem to help...DuoNeb and albuterol inhaler seems to help for short time...Nucala for 6 months with no help, discontinued. Dupixent was started 2 months ago with minimal improvement, discontinued...The patient was treated with itraconazole and has shown significant clinical improvement. He is scheduled for a follow-up CT after a..."

Clinical • Allergic Bronchopulmonary Aspergillosis • Allergic Rhinitis • Allergy • Asthma • Barrett Esophagus • Bronchiectasis • Cardiovascular • Cough • Diabetes • Gastroenterology • Gastroesophageal Reflux Disease • Gastrointestinal Disorder • Hypertension • Immunology • Infectious Disease • Inflammation • Metabolic Disorders • Pain • Pulmonary Disease • Respiratory Diseases • Type 2 Diabetes Mellitus • Xerostomia

"Duonebs" (@Matt_Maslonka)

Achromobacter Xylosoxidans Complicating Mycobacterium Avium Fibrocavitary Lung Disease (ATS 2022) - "About 2 years ago, patients sputum culture showed mycobacterium avium which had developed resistance to ethambutol, being on maintenance azithromycin and rifampin since...He was started on IV azithromycin, cefepime, IV methylprednisone 60 mg and scheduled duonebs.Gram stain on sputum showed 2+ white cells, 1+ gram positive cocci in pairs, 1+ gram negative rods and 1+ gram positive rods...Antibiotics changed to levofloxacin following sensitivity studies which resulted in clinical improvement...Studies have implicated a decline in lung function (FEV1) following infection with this organism, particularly if untreated, due to persistent inflammation of the respiratory tract. Our patient serves to highlight the importance of identifying the pathogenicity of this unusual organism and appropriate intervention."

Cough • Immunology • Infectious Disease • Inflammation • Pneumonia • Pulmonary Disease • Respiratory Diseases

Renal Transplant in Severe COPD and Granulomatosis with Polyangiitis (GPA) (ATS 2022) - "Post op, she was started on incentive spirometry, pain control and immunosuppression medication (anti-thymocyte, methylprednisolone, tacrolimus and mycophenolate mofetil) without complications. POD 1 she received Bactrim, valganciclovir and nystatin...She ambulated without shortness of breath, and without requiring duonebs during hospitalization... Kidney transplant is safe in patient with GPA on ESRD, even with COPD with severe obstruction."

Chronic Obstructive Pulmonary Disease • Genito-urinary Cancer • Glomerulonephritis • Immunology • Lupus Nephritis • Nephrology • Oncology • Pain • Pulmonary Disease • Rare Diseases • Renal Cell Carcinoma • Respiratory Diseases • Solid Tumor • Transplant Rejection • Transplantation • Vasculitis

[VIRTUAL] Stent Salvage in Malignant Airway Obstruction: A Case Report of Dornase Alfa as Adjunct Therapy (ATS 2021) - "Addition of Dornase alfa should be considered in patients with repeated stent occlusion not amenable to DuoNeb and humified 3% hypertonic saline therapy. In the case of our patient, twice daily use provided significant palliation of symptoms. This case is proof of concept, but further studies are required in this specific population to further establish longer term clinical benefit."

Clinical • Chronic Obstructive Pulmonary Disease • Cystic Fibrosis • Fibrosis • Genetic Disorders • Hematological Disorders • Immunology • Oncology • Respiratory Diseases

[VIRTUAL] Cocaine-Induced Asthma Exacerbation Causing Respiratory Failure (ATS 2021) - "The patient’s respiratory function improved with mechanical ventilation and continuous DuoNeb treatment...Also, his rapid respiratory improvement and negative bronchoscopy in the setting of his UDS results point to an exacerbation caused by cocaine. This case study reaffirms the need to view cocaine as a plausible trigger of asthma exacerbations."

Asthma • Cardiovascular • CNS Disorders • Hematological Disorders • Immunology • Pulmonary Disease • Respiratory Diseases • Vascular Neurology

Feasibility, Safety and Efficacy of Nebulized Long-Acting Bronchodilators (Formoterol and Revefenacin) vs. Short-Acting Bronchodilators (Albuterol and Ipratropium) in Hospitalized Patients With AECOPD (clinicaltrials.gov) - P4; N=60; Not yet recruiting; Sponsor: University of Tennessee Graduate School of Medicine

Clinical • New P4 trial • Chronic Obstructive Pulmonary Disease • Immunology • Respiratory Diseases

Trial of AccuPAP Device Versus Standard Nebulizer Therapy in Acute Asthma Exacerbation in Children (clinicaltrials.gov) - P=N/A; N=0; Withdrawn; Sponsor: Vanderbilt University Medical Center; N=120 ➔ 0; Trial completion date: Jun 2023 ➔ Nov 2020; Recruiting ➔ Withdrawn; Trial primary completion date: Jun 2022 ➔ Nov 2020

Clinical • Enrollment change • Trial completion date • Trial primary completion date • Trial withdrawal • Asthma • Respiratory Diseases

[VIRTUAL] Local Nasal Cutaneous Vasoconstriction: A Complication Of Inhaled Racemic Epinephrine With Duoneb In An Adult (ASA 2020) - "Duoneb and decadron were given before transport. Her skin recovered quickly. Localized ischemia due to cutaneous exposure to epinephrine is extremely rare."

Clinical • Asthma • Respiratory Diseases

[VIRTUAL] HERNIATION OF AN EMPHYSEMATOUS PULMONARY BULLA INTO THE INTERCOSTAL SPACE (CHEST 2020) - "He had a past medical history of COPD, pulmonary fibrosis, and RA (treated with Rituxan, Azathioprine, and Prednisone). Prior to hospitalization, he was treated with a 5-day course of Azithromycin and 20 mg of Prednisone...The patient’s status improved with DuoNeb, mucolytics, spirometry, lidocaine patches, tramadol and acapella valve use... Herniation of emphysematous bullae is a very rare condition and complication, very few cases have been reported. The clinical presentation is nonspecific, and the use of chest X-ray does not always identify the herniation. In most of the reported cases, the diagnosis can be confirmed with a chest tomography."

Chronic Obstructive Pulmonary Disease • Fibrosis • Idiopathic Pulmonary Fibrosis • Immunology • Mood Disorders • Musculoskeletal Diseases • Orthopedics • Pain • Respiratory Diseases