A COPD patient reports that ipratropium bromide is ineffective. What should the nurse practitioner do next?

In this scenario, adding an albuterol inhaler is a logical next step for managing a patient with chronic obstructive pulmonary disease (COPD) who finds ipratropium bromide ineffective. Ipratropium bromide is an anticholinergic medication that helps to relax the muscles around the airways and increase airflow to the lungs, but for some patients, especially those experiencing acute symptoms or exacerbations, additional bronchodilation may be necessary.

Albuterol, a short-acting beta-agonist, provides rapid relief of bronchospasm by relaxing the smooth muscle in the airways. For patients with COPD who are not responding adequately to anticholinergic therapy alone, the use of a beta-agonist can provide complementary action. The combination of ipratropium bromide and albuterol is often more effective because they target different pathways in bronchial smooth muscle, resulting in enhanced bronchodilation.

Increasing the dose of ipratropium bromide might not be effective if the medication is already deemed ineffective. Higher doses can lead to increased side effects without necessarily improving therapeutic outcomes. Starting oxygen therapy may be appropriate in cases of hypoxemia, but it does not address the immediate issue of ineffective medication for bronchospasm.