Combivent Respimat is a soft-mist inhaler that delivers two airway-opening medications in a single puff. It combines ipratropium bromide, which blocks nerve signals that tighten airway muscles, with albuterol, which directly relaxes smooth muscle from the windpipe down to the smallest airways. Using it correctly involves three stages: a one-time assembly, priming before first use, and a simple Twist-Open-Press routine for each dose.
Assembling the Inhaler for the First Time
The Respimat device arrives as two separate pieces: the inhaler body and a medication cartridge. You only need to assemble it once, and the device should never be taken apart afterward.
Start by pressing the safety release button on the inhaler and gently pulling the clear base free from the body. Avoid reaching inside the device, because there is a sharp piercing tool that punctures the cartridge. Insert the cartridge narrow end first into the inhaler body. You’ll feel it seat at the top, but about an eighth of an inch will still stick out. That’s normal. Snap the clear base back into place until you hear and feel it click shut.
Priming Before First Use
Before you inhale your first dose, the inhaler needs to be primed. This loads the internal mechanism and ensures you get a full, consistent spray. With the cap closed, turn the clear base in the direction of the arrows on the label until it clicks (this is about a half turn). Then open the cap fully until it snaps into place. Point the mouthpiece away from your face and press the dose-release button. Repeat this twist-open-press cycle, spraying toward the ground or away from people, until you see a visible aerosol cloud. Once you see that cloud, do three more sprays. The inhaler is now ready for regular use.
The Twist-Open-Press (T-O-P) Routine
Every dose follows the same three steps:
- Twist: Keep the cap closed. Turn the clear base in the direction of the arrows until it clicks. This loads one dose.
- Open: Flip the cap open until it snaps fully upright.
- Press: Breathe out slowly and completely. Close your lips around the mouthpiece without covering the air vents on the sides. Point the inhaler toward the back of your throat. As you begin a slow, deep breath in through your mouth, press the dose-release button and keep breathing in steadily. Hold your breath for 10 seconds, or as long as you comfortably can. Then close the cap.
The slow inhalation is critical. Unlike a traditional pressurized inhaler that fires a fast blast, the Respimat produces a slow-moving soft mist. Breathing in too quickly can cause the medication to hit the back of your throat instead of reaching deep into your lungs. Think of it as a gentle, steady sip of air rather than a sharp gasp.
Re-Priming After Missed Days
If you haven’t used your Respimat in more than 3 days, spray one puff into the air (away from your face) before taking your dose. If it’s been more than 21 days since your last use, you need a fuller re-prime: spray toward the ground until you see a visible cloud, then do three additional sprays. These re-priming puffs do use up doses from the cartridge, so keep that in mind when tracking how much medication is left.
Cleaning the Mouthpiece
Medication residue can build up inside the mouthpiece over time and partially block the spray. Clean it at least once a week by wiping the inside of the mouthpiece, including the metal tip, with a damp cloth or tissue. Don’t put the device in water or run it under a faucet. Let it air dry completely before using it again. Never try to disassemble the inhaler for cleaning.
How the Two Medications Work Together
The combination in Combivent Respimat opens your airways through two different pathways, which is why it can work better than either ingredient alone. Albuterol activates receptors on airway muscle cells that trigger relaxation. It works quickly, typically within minutes. Ipratropium takes a different route: it blocks the chemical messenger acetylcholine, which your nervous system uses to signal airway muscles to tighten. By hitting both pathways at once, the inhaler provides broader and often longer-lasting relief than a single-ingredient bronchodilator.
Precautions Worth Knowing
The ipratropium component is an anticholinergic, which means it can affect more than just your lungs. It may raise pressure inside the eye, which is a concern if you have narrow-angle glaucoma. If you notice eye pain, blurred vision, or halos around lights after using the inhaler, that warrants prompt attention. Be especially careful not to spray the mist directly into your eyes.
Anticholinergics can also make it harder to empty your bladder. If you have an enlarged prostate or a history of bladder-neck obstruction, you may notice increased difficulty urinating. This side effect is uncommon at inhaled doses but worth watching for, particularly when you first start using the device.
Tracking Your Remaining Doses
The Respimat has a built-in dose indicator on the side of the cartridge. As you use doses, the indicator gradually moves toward zero. When the pointer reaches the red zone, you’re running low and should have a replacement cartridge ready. Once the indicator hits zero, the device locks and will no longer spray, even if some liquid appears to remain in the cartridge. Don’t try to extract extra doses beyond this point, because the medication delivery is no longer accurate. Each cartridge is designed for a set number of actuations, and priming and re-priming sprays count against that total.