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

Rosai-Dorfman Disease Presenting as a Subglottic Mass (AHNS 2026) - "The patient was being followed by pulmonology, where she was prescribed Symbicort and Albuterol as needed. Upon arrival at the emergency department, she was given Prednisone, Duonebs, and racemic epinephrine nebulization with minimal improvement...However, some cases may show spontaneous regression, but treatments that have been shown to improve symptoms are surgery, steroids, radiation, chemotherapy, Sirolimus, and immunomodulators (2)... In conclusion we present a 59-year-old female with worsening airway symptoms who was shown to have Rosai-Dorfman Disease with isolated subglottic involvement. Her symptoms improved following debulking surgery, and she was discharged home in good condition. She was decannulated one month after discharge."

Hematological Malignancies • Infectious Disease • Laryngeal Cancer • Lymphoma • Otorhinolaryngology • Pneumonia • Pulmonary Disease • Rare Diseases • Respiratory Diseases • Solid Tumor

Improving Pediatric Asthma Management in Community Emergency Departments (PAS 2026) - "There exists a wide variety in how these patients are treated in the community, especially at hospitals without pediatric emergency medicine (PEM) trained physicians, despite evidence based guidelines on the use of early and multiple albuterol-ipratropium nebulizers (DuoNeb) for moderate asthma exacerbations...Data will be analyzed and charted on a run chart to show how outcomes changed over time and with education interventions. Data to be analyzed by January 2026."

Clinical • Asthma • Immunology • Pediatrics • Respiratory Diseases

Treating Respiratory Emergencies in Children Study (T-RECS): A pilot trial of prehospital treatment for life-threatening pediatric asthma. (PubMed, J Asthma) - P2 | "The Treating Respiratory Emergencies in Children Study (T-RECS) pilot study evaluated the feasibility of a prehospital treatment protocol for life-threatening pediatric asthma, including combined albuterol/ipratropium (DuoNeb) and dexamethasone with a checklist, to inform a future trial. This pilot trial evaluated the feasibility and acceptability of implementing a prehospital protocol for severe pediatric asthma. While hospital data collection needs to be improved, these findings provide important considerations for a larger trial to evaluate the impact of this intervention on patient outcomes."

Journal • Asthma • Immunology • Pediatrics • Pulmonary Disease • Respiratory Diseases

GIANT BULLAE AND PNEUMOTHORAX IN A PATIENT WITH SEVERE BULLOUS EMPHYSEMA: DIAGNOSTIC AND CLINICAL CONSIDERATIONS (CHEST 2025) - "He was admitted to the step-down unit, treated for community-acquired pneumonia, and given DuoNebs and steroids... A patient with giant bullae secondary to emphysematous disease can pose a diagnostic challenge on initial presentation. CT scan of the chest should be performed if chest x-ray is equivocal, with the double wall sign being a diagnostic aid. Any comorbidities such as smoking, illicit drug abuse, HIV, alpha-1 antitrypsin deficiency etc., that can lead to poor progression must be identified and treated."

Clinical • Alpha-1 Antitrypsin Deficiency • Cardiovascular • Chronic Obstructive Pulmonary Disease • Cough • Genetic Disorders • Hepatology • Human Immunodeficiency Virus • Immunology • Infectious Disease • Pneumonia • Pulmonary Arterial Hypertension • Pulmonary Disease • Respiratory Diseases • CD4

SUBACUTE INVASIVE ASPERGILLOSIS WITH NODULAR LESIONS IN A BACKGROUND OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE: A RARE PHENOMENON (CHEST 2025) - "Initial labs were notable for elevated troponin, elevated pro-BNP, leukopenia, anemia, and positive for influenza A. He was treated with broad spectrum antibiotic therapy community acquired pneumonia and anaerobic organism coverage, and he was started on Tamiflu. COPD was managed with DuoNeb treatments and fluticasone while inpatient...Patient was initiated on voriconazole and followed outpatient for further monitoring... SAIA is a subtype of CPA which can be difficult to diagnosis as clinical presentation and imaging findings can be nonspecific. Diagnosis is typically made with BAL aspergillus antigen testing and histology demonstrating fungal hyphae. Treatment typically involves prolonged triazole therapy with follow-up imaging to ensure response."

Addiction (Opioid and Alcohol) • Anemia • Back Pain • Cardiomyopathy • Cardiovascular • Chronic Obstructive Pulmonary Disease • Cough • Human Immunodeficiency Virus • Hypertension • Immunology • Infectious Disease • Influenza • Leukopenia • Musculoskeletal Pain • Pneumonia • Pulmonary Disease • Respiratory Diseases • Tuberculosis • Venous Thromboembolism

THE UNCLASSIFIED PHENOTYPE: SEVERE PULMONARY HYPERTENSION WITH LOW DLCO AND CAPILLARY REMODELING CHALLENGING DIAGNOSTIC BOUNDARIES: A CASE REPORT (CHEST 2025) - "He was initiated on IV steroids, DuoNeb, and budesonide nebulizations, along with IV diureses...The patient was aggressively diuresed and was initiated on inhaled Flolan therapy. Given the severity of his PH with reduced CI and severely elevated PVR, the patient was then transferred to a tertiary care center for IV Epoprostenol therapy and evaluation for a lung transplant... This case report highlights the diagnostic challenges and the importance of considering capillary remodeling in patients with rapidly progressing severe PH with low DLCO and smoking history and a need for early referral to lung transplant. Advanced imaging, genetic studies, and more detailed clinical profiles can aid in refining diagnostic criteria and potentially lead to new subcategories in PH classification that are more inclusive of these phenotypes."

Case report • Clinical • Cardiovascular • Congestive Heart Failure • Dyslipidemia • Heart Failure • Immunology • Nicotine Addiction • Pulmonary Arterial Hypertension • Pulmonary Disease • Respiratory Diseases • Tobacco Addiction

An Unrelenting Asthma Exacerbation: A Tough Nut to Crack (AAP-NCE 2025) - "On the evening of admission, he had choked on a walnut and parents took him to an outside ED where he tested positive for Influenza B. He received dexamethasone IM, nebulized albuterol, DuoNeb x 2, and racemic epinephrine x 2. Our case emphasizes considering FBAs with persistent or worsening respiratory symptoms, particularly in young children with no wheezing history, using multiple view CXRs to detect signs like air trapping, and inquiring about choking events to reduce delayed parental recall. Timely diagnosis prevents irreversible bronchiectasis."

Asthma • Atopic Dermatitis • Bronchiectasis • Cardiovascular • Cough • Dermatology • Immunology • Infectious Disease • Influenza • Novel Coronavirus Disease • Pneumonia • Pulmonary Disease • Respiratory Diseases

Rectus Sheath Hematoma-Induced Abdominal Compartment Syndrome: A Case Report (ATS 2025) - "On admission, her oxygen saturation (SaO2) was 75%, which improved to 97% with 4L oxygen via nasal cannula, DuoNebs, and IV Solu-Medrol...After another AF episode and with a CHA2DS2-VASc score of 4, her Cardizem was increased to 120 mg twice daily, and she was started on Lovenox 60 mg twice daily for stroke prevention...Consultations with general surgery and urology were obtained, and an evacuation of the abdominal and pelvic hematomas was performed. Following decompressive laparotomy, the patient's AKI resolved, and after a prolonged hospital stay, she was discharged to a rehabilitation facility."

Case report • Clinical • Acute Kidney Injury • Atrial Fibrillation • Back Pain • Cardiovascular • Hypotension • Infectious Disease • Musculoskeletal Pain • Nephrology • Pain • Pneumonia • Renal Disease • Respiratory Diseases • Urology

Complex ICU Management of Eosinophilic Granulomatosis With Polyangiitis (ATS 2025) - "Discharged 3weeks later on IV meropenem and Vancomycin, Duonebs , prednisone taper and pulmonary follow up. This case necessitated involvement of different specialties to determine the best course of treatment when dealing with EGPA systemic complications to reduce morbidity and mortality. Understanding the systemic pathology of EFPA can help further management."

Allergic Rhinitis • Asthma • Cardiomyopathy • Cardiovascular • Eosinophilia • Eosinophilic Granulomatosis With Polyangiitis • Gastroenterology • Gastrointestinal Disorder • Genetic Disorders • Immunology • Infectious Disease • Langerhans Cell Histiocytosis • Nasal Polyps • Obesity • Otorhinolaryngology • Pain • Pneumonia • Rare Diseases • Respiratory Diseases • Septic Shock • Vasculitis

Rare Case of Nut Allergy After Lung Transplant (ATS 2025) - "Initial treatment included duonebs and bronchoscopy, revealing a normal airway architecture but notably stiff lungs...The safest management includes avoiding all nuts, chickpeas, and sesame seeds, with an epinephrine auto-injector for emergency use. This case underscores the importance of monitoring for food allergies in transplant recipients, especially when the donor has a history of allergies."

Clinical • Allergy • Food Hypersensitivity • Immunology • Pediatrics • Solid Organ Transplantation • Transplantation

A Performance Comparison of Three Nebulizers Delivering a Combination of Ipratropium/Albuterol Inhalation Solution (ATS 2025) - "This study aimed to compare three nebulizers by assessing in-vitro Fine Droplet Mass (FDM<4.7μm) and aerosol characteristics of a combination of ipratropium/albuterol over time. AeroEclipse® II BAN® Nebulizer (AE), AirLife™ Misty Fast™ (MF) and Circulaire® II (CA) devices (n=5) were filled with 1 DuoNeb® (ipratropium bromide 0.5 mg/ albuterol sulfate 3.0 mg) vial. All nebulizers showed consistent incremental increases in delivered doses of each medication minute by minute. The AeroEclipse® BAN® Nebulizer provided the highest FDM in substantially less time compared to the other nebulizers tested making this a reasonable option for recognizing a time savings by offering a timed treatment option. The effectiveness of small volume nebulizers can vary greatly, making it crucial to choose the right one to optimize drug delivery and achieve the best therapeutic outcomes."

Chronic Obstructive Pulmonary Disease • Immunology • Pulmonary Disease • Respiratory Diseases

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