
Combivent (ipratropium bromide and albuterol sulfate, also known internationally as ipratropium/salbutamol; some markets include the brand Duolin) combines two proven short-acting bronchodilators to open the airways quickly and help you breathe easier. By pairing an anticholinergic with a beta-2 agonist, Combivent is designed for adults with COPD who need more than a single bronchodilator to control symptoms. In some regions, clinicians may also use this combination in select asthma cases, particularly during exacerbations under medical supervision. If your care team recommends a controller option to reduce inflammation, a maintenance inhaler such as Advair may complement your regimen.
What is Combivent (Ipratropium/Albuterol)?
Combivent is a dual-bronchodilator therapy intended to relieve bronchospasm—sudden narrowing of the airways that causes wheezing, chest tightness, and shortness of breath. Each active ingredient targets a different pathway that contributes to airway constriction:
- Ipratropium bromide: An anticholinergic that blocks muscarinic receptors in the bronchial smooth muscle, reducing vagal-mediated bronchoconstriction and mucus secretion.
- Albuterol (salbutamol): A short-acting beta-2 agonist (SABA) that relaxes airway smooth muscle by stimulating beta-2 receptors, providing rapid relief of bronchospasm.
For adults with COPD—chronic bronchitis, emphysema, or both—this complementary mechanism can offer greater bronchodilation than either component alone. The combination is not a steroid and does not treat airway inflammation. Many patients will use Combivent alongside a long-term controller inhaler as part of a comprehensive COPD management plan developed by their clinician.
How Combivent Works: Dual Bronchodilation for COPD
COPD airways are prone to constriction from smooth muscle spasm, excess mucus, and inflammation. Combivent addresses the bronchoconstrictive component through two synchronized actions:
- Anticholinergic effect (ipratropium): Inhibits the action of acetylcholine on M3 receptors, helping prevent reflex bronchoconstriction and reducing secretions. The effect is typically noticeable within 15 minutes, with beneficial airflow improvements over the next 1–2 hours.
- Beta-2 agonist effect (albuterol): Stimulates beta-2 receptors to relax airway smooth muscle quickly—often within 5 minutes—with peak effect around 30–60 minutes.
Together, the two agents can produce more pronounced and sustained bronchodilation than either drug alone. This can translate into fewer symptoms, improved exercise tolerance, and better day-to-day breathing for many patients. However, Combivent is not a replacement for oxygen therapy, pulmonary rehabilitation, or smoking cessation where needed—these remain cornerstone interventions in COPD care.
Available Forms, Strengths, and Devices
Combivent has been supplied in different formats depending on market and manufacturer. Availability can vary by country:
- Soft-mist inhaler (Respimat type): Common in the U.S. and several other regions. Typical labeled strengths deliver 20 mcg ipratropium and 100 mcg albuterol per inhalation (per actuation), with a recommended schedule of one inhalation four times daily, not to exceed six inhalations in 24 hours unless specifically directed by your clinician.
- Pressurized metered-dose inhaler (pMDI): Older HFA-propelled canisters, including certain branded or international generics (e.g., Duolin in select markets), often provided 200 metered actuations per canister. Historical directions commonly recommended two puffs four times daily, with a defined maximum daily puff count per local label.
- Nebulized solution: In some settings, a unit-dose vial combining ipratropium and albuterol is used via nebulizer for patients who cannot coordinate inhaler use or during acute care under supervision.
Your clinical team will select the device and dosing that align with your local product label, symptom profile, manual dexterity, and inhalation technique. Always follow the exact directions provided with your device and by your prescriber.
How to Use Combivent: Dosing and Inhaler Technique
Use Combivent exactly as prescribed. Standard maintenance use for COPD is typically four times daily. Do not exceed the maximum daily dose on your label. If you find you need more frequent doses, contact your care team promptly—this can be a sign that your COPD is not well controlled and your treatment plan may need adjustment.
General guidance for best results:
- Prime before first use: New devices and those not used for several days usually require priming sprays to ensure accurate dosing. Follow the device-specific priming instructions in your patient leaflet.
- Exhale fully: Before actuating the inhaler, breathe out gently to empty your lungs.
- Seal lips and breathe in deeply: Place the mouthpiece between your lips, start to breathe in slowly and deeply, and press the canister or dose-release button to deliver the medication.
- Hold your breath: After inhalation, hold your breath for about 10 seconds or as long as comfortable, then exhale slowly.
- Wait between inhalations: If more than one inhalation is prescribed, wait at least 30–60 seconds between actuations to improve deposition.
- Protect your eyes: Avoid spraying into the eyes, especially important with ipratropium-containing products. Accidental ocular exposure can precipitate or worsen narrow-angle glaucoma symptoms.
Missed dose: Take it as soon as you remember unless it is almost time for your next dose. Do not double up to make up for a missed dose.
Inhaler hygiene: Clean the mouthpiece regularly per the manufacturer’s directions. Debris or residue can affect dose delivery and hygiene. For soft-mist devices, wipe the mouthpiece with a damp cloth; for pMDIs, remove the canister before rinsing the plastic actuator unless your leaflet instructs otherwise. Allow parts to dry completely before reassembly.
Onset, Duration, and What to Expect
Most users feel some relief within minutes. Peak effects generally occur within an hour, with bronchodilation persisting for several hours. Because Combivent contains short-acting components, it is intended for regular, scheduled use in COPD rather than once-daily dosing. If you require a rescue inhaler for sudden shortness of breath, your clinician may also prescribe a separate rapid-acting SABA inhaler and will instruct you on appropriate use alongside Combivent.
Who Should Use Combivent—and Who Should Not
Combivent is intended for adults with COPD who need dual bronchodilation. It is not considered a first-line controller for asthma in most guidelines, although the components are used acutely in clinical settings. Use only under medical guidance in asthma.
Do not use Combivent if you have a known hypersensitivity to ipratropium, atropine or its derivatives, albuterol, or any product components. Older propellant formulations of ipratropium-containing MDIs historically contained soya lecithin; people with severe soy or peanut allergies were advised to avoid those specific canisters. Many current devices (such as Respimat soft-mist inhalers) do not contain soya lecithin, but always check your specific product’s ingredients and consult your pharmacist if unsure.
Important Precautions and Drug Interactions
Before starting therapy, tell your clinician if you have any of the following:
- Cardiovascular disease, arrhythmias, or hypertension
- Narrow-angle glaucoma
- Urinary retention, prostate enlargement, or bladder outflow obstruction
- Hyperthyroidism or diabetes
- Seizure disorders
- Liver or kidney impairment
- Pregnancy, plans for pregnancy, or breast-feeding
Potential interactions include:
- Other anticholinergics: May increase anticholinergic side effects (dry mouth, urinary retention).
- Other beta-agonists: May amplify tremor, palpitations, or tachycardia; avoid unnecessary duplication.
- MAO inhibitors or tricyclic antidepressants: Can potentiate cardiovascular effects; use with caution if used within the past two weeks.
- Nonselective beta-blockers (e.g., propranolol): May blunt albuterol’s effect and can provoke bronchospasm in susceptible individuals.
- Diuretics that deplete potassium: Combined with beta-agonists, can increase risk of hypokalemia; monitor if clinically indicated.
- Digoxin: Beta-agonists may affect serum digoxin levels; monitor as appropriate.
Alcohol, caffeine, and nicotine can also influence heart rate or respiratory symptoms. Discuss your full medication and lifestyle profile with your clinician to personalize your plan.
Side Effects: Common, Less Common, and Serious
Many patients tolerate Combivent well, especially when using correct technique and dosing. Potential side effects include:
- Common: Dry mouth, cough, mild throat irritation, hoarseness, headache, dizziness, tremor, nervousness, nausea, unusual taste.
- Less common: Palpitations, increased heart rate, muscle cramps, insomnia, urinary retention (especially in men with BPH), increased sputum, nasal or sinus irritation.
- Ocular: Blurred vision, eye pain, halos, or redness if medication contacts the eyes; this can signal worsening narrow-angle glaucoma—seek urgent care.
- Metabolic: Transient changes in blood sugar or potassium, more likely at high doses or with interacting medicines.
- Hypersensitivity: Rash, hives, swelling, or anaphylaxis is rare but requires immediate medical attention.
- Paradoxical bronchospasm: Very rarely, inhaled bronchodilators can cause unexpected worsening of breathing; if this occurs, stop the medication and seek immediate care.
Contact your healthcare provider promptly if side effects are severe, persistent, or concerning. If you develop chest pain, marked shortness of breath unrelieved by your usual inhalers, fainting, or signs of an acute eye emergency, call emergency services.
Special Populations: Older Adults, Pregnancy, and Breastfeeding
Older adults may be more susceptible to anticholinergic effects (constipation, urinary retention) and cardiovascular responses to beta-agonists. Start at labeled doses and monitor tolerability.
Pregnancy and breastfeeding: Combivent is not known to be teratogenic at therapeutic doses, and systemic absorption of ipratropium is low. Albuterol has the longest safety experience among SABAs. Still, treatment decisions should weigh maternal respiratory stability—a critical determinant of fetal oxygenation—against any potential risks. Discuss benefits and risks with your obstetric and pulmonary teams. If breastfeeding, monitor infants for irritability or feeding changes, though significant transfer is considered unlikely at standard inhaled doses.
Daily Life with COPD or Asthma: Practical Tips
- Pair bronchodilation with lifestyle measures: Pulmonary rehab, regular physical activity, smoking cessation, and vaccination (influenza, pneumococcal) improve outcomes.
- Know your triggers: Cold air, pollution, allergens, and respiratory infections commonly worsen symptoms. Plan activities around air quality and weather when possible.
- Use a spacer only if recommended: Spacers are typically used with pMDIs, not soft-mist devices. Ask your pharmacist which accessories fit your device.
- Track dose counts: Soft-mist inhalers and pMDIs have defined lifespans; many include dose indicators. Replace devices as directed to avoid underdosing.
- Have an action plan: Work with your clinician to create a written plan for flare-ups—what to take, when to seek care, and whom to call.
Storage, Handling, and Device Care
Store your inhaler at room temperature away from excess heat, cold, and moisture. Do not puncture or incinerate pressurized canisters. Keep all medications out of reach of children and pets.
- Soft-mist devices (Respimat type): After inserting a new cartridge and priming, many devices are intended for use over approximately three months. Check your device’s label for specific discard timing after first use.
- pMDIs: Many canisters provide 200 actuations. Discard after reaching the labeled actuation count, even if the canister still seems to contain propellant—dose accuracy is no longer assured.
- Cleaning: Follow the manufacturer’s instructions. Regular cleaning maintains dose accuracy and reduces contamination risk.
Combivent vs. Alternatives
Choosing the right inhaler is individualized. Considerations include symptom burden, exacerbation history, spirometry, comorbidities, and inhaler technique. Options your clinician may discuss include:
- Single bronchodilator therapy: A SABA (e.g., albuterol) or a short-acting anticholinergic (ipratropium) used alone; may be adequate for milder symptoms but often less effective than combination therapy for many COPD patients.
- Long-acting bronchodilators: LAMA (e.g., tiotropium, umeclidinium) or LABA (e.g., salmeterol, formoterol) once or twice daily for longer control; may be used alone or in combination (LAMA/LABA) for moderate to severe COPD.
- Inhaled corticosteroid combinations: ICS/LABA or triple therapy (ICS/LABA/LAMA) for patients with frequent exacerbations, elevated eosinophils, or asthma-COPD overlap, per guideline-based assessment.
- Nebulized regimens: For those who cannot use handheld devices reliably, nebulized bronchodilators are an alternative—often used in acute care or home settings with clinician oversight.
Combivent can be a strong option when a short-acting dual approach is appropriate, particularly during periods of increased symptoms or as part of a broader COPD plan. Your clinician will help determine where Combivent fits based on your specific goals and risk profile.
Recommendations for Safe, Effective Use
- Use as scheduled: Regular dosing provides steadier bronchodilation than intermittent use alone.
- Avoid heat sources: Do not use near an open flame or while smoking.
- Do not exceed labeled maximums: Overuse increases side effect risk and may mask a worsening condition that needs medical evaluation.
- Coordinate with other inhalers: If you have multiple inhalers, your clinician can help you sequence them—typically a bronchodilator first, then other therapies.
- Monitor response: A symptom diary and periodic peak flows or spirometry (as recommended) can guide adjustments.
Ingredients
Active ingredients: ipratropium bromide and albuterol sulfate (salbutamol sulfate). Inactive ingredients vary by device and manufacturer. If you have allergy concerns—especially regarding historical formulations that used soya lecithin—review the patient leaflet or consult your pharmacist for the exact excipients in your product.
Access, Pricing, and Genuine Supply
We serve customers in the USA, Canada, and the UK through licensed channels. Authenticity and appropriate handling are essential for inhaler performance and your safety. Each unit is sourced through regulated supply chains, and our support team can assist with product verification, device setup, and technique counseling resources.
If your clinician recommends adding a controller medication, you can explore options such as Advair and other maintenance inhalers that address airway inflammation. Combination strategies often deliver superior control compared with short-acting bronchodilators alone.
Additional Information
Your respiratory care plan should be personalized. Discuss any new or worsening symptoms, nighttime awakenings, activity limitations, or frequent need for rescue medication with your clinician. If you experience signs of infection—fever, discolored sputum, chest pain—or a notable drop in exercise tolerance, seek medical advice promptly. Never stop or change medications without professional guidance unless you suspect an urgent adverse reaction.
For assistance with placing an order, product selection, or device instructions, our customer care team is available to help. We prioritize patient privacy, secure checkout, and discreet shipping. Information on our data protection standards is available on our privacy policy page.
Combivent U.S. Sale and Prescription Policy
In the United States, Combivent is a prescription medication. Dispensing must comply with federal and state regulations, and clinical oversight is essential to ensure appropriate use, screening for contraindications, and coordination with a patient’s broader COPD or asthma management plan. Many jurisdictions permit modern care pathways—such as telehealth evaluations, standing orders, or collaborative practice agreements—that allow eligible adults to obtain therapy after a structured clinical assessment, even when a traditional paper prescription is not issued in hand.
HealthSouth Rehabilitation Hospital of Jonesboro offers a legal and structured solution for acquiring Combivent without a formal prescription, operating within applicable U.S. laws and professional standards. This means your eligibility is reviewed through clinician-directed protocols, necessary safety checks are performed, and dispensing occurs through licensed pharmacy channels. We act as resellers for BLINK HEALTH PHARMACY LLC, and all medications are supplied through regulated systems. Patients should complete any required health questionnaire or telehealth intake honestly and keep their primary clinician informed, especially if they use other respiratory medicines or have cardiovascular, ocular, or urinary conditions that require monitoring.
Availability and specific procedural requirements can vary by state. If a direct prescription from your clinician is preferred, we also support conventional prescribing and can coordinate fulfillment through licensed partners. Regardless of pathway, our goal is to ensure safe access, evidence-based guidance, and continuity of care.
Combivent FAQ
What is Combivent and what is it used for
Combivent (ipratropium bromide and albuterol) is a prescription inhaler used to treat bronchospasm in adults with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema. It combines a short-acting anticholinergic (ipratropium) and a short-acting beta-agonist (albuterol) to open airways and improve breathing.
How does Combivent work
Albuterol relaxes airway smooth muscle quickly by stimulating beta-2 receptors, while ipratropium blocks muscarinic receptors to reduce airway constriction and mucus. The dual action provides broader bronchodilation than either medicine alone.
Is Combivent a rescue inhaler or a maintenance inhaler
Combivent is a short-acting bronchodilator intended for symptom relief and as scheduled dosing in COPD (often four times daily). It is not a long-term maintenance controller like LABA/LAMA combinations and does not replace inhaled corticosteroids when those are indicated.
How fast does Combivent start working and how long do effects last
Albuterol’s relief often begins within minutes, while ipratropium adds benefit that can build over 15–30 minutes. The combined effect typically lasts 4–6 hours for albuterol and up to about 6–8 hours for ipratropium, though response varies.
Who should consider Combivent
Adults with COPD who need more relief than a single short-acting bronchodilator may benefit, especially those with frequent symptoms or exacerbations. Your clinician may recommend it if you’re already using albuterol or ipratropium alone without adequate control.
How do I use the Combivent Respimat inhaler correctly
Exhale fully, seal your lips around the mouthpiece, and inhale slowly and deeply as you press the dose-release button, then hold your breath for up to 10 seconds before exhaling. Prime the device before first use and if not used for a period, and clean the mouthpiece weekly; follow the patient instructions for priming and handling.
What is the usual dose of Combivent Respimat
A common regimen is one inhalation four times daily, with additional inhalations as needed, not to exceed six inhalations in 24 hours. Always follow the specific dosing your prescriber gives you.
What if I miss a dose of Combivent
If you miss a scheduled dose, take it when you remember unless it’s close to your next dose. Do not double up; resume your regular schedule and call your clinician if you’re needing it more often than prescribed.
What are common side effects of Combivent
Dry mouth, cough, throat irritation, tremor, nervousness, headache, dizziness, and a rapid heartbeat can occur. Most are mild and temporary; drinking water and using good inhaler technique can help reduce throat irritation and dryness.
What serious side effects should I watch for
Stop and seek medical care if you experience worsening wheeze right after use (paradoxical bronchospasm), chest pain, severe palpitations, severe dizziness, allergic reactions (rash, swelling, trouble breathing), painful or difficult urination, or eye pain/blurred vision with halos.
Can Combivent affect my eyes if the mist gets in them
Yes. Getting the spray in your eyes can trigger or worsen narrow-angle glaucoma and cause eye pain, blurred vision, or halos; always direct the mouthpiece correctly and consider protective eyewear if you’re prone to misfiring.
Who should not use Combivent
Avoid if you’ve had a serious hypersensitivity to ipratropium, albuterol, or their components. Use caution and consult your clinician if you have narrow-angle glaucoma, enlarged prostate or urinary retention, cardiovascular disease, hyperthyroidism, seizures, or diabetes.
Is Combivent approved for asthma
Combivent is indicated for COPD. It is not approved as routine asthma therapy; if considered in select situations, it should be under specialist guidance and is not a substitute for inhaled corticosteroids in asthma.
Can children use Combivent
Safety and effectiveness of Combivent Respimat have not been established in pediatric patients. It is generally prescribed for adults with COPD.
How should I store Combivent and when should I discard it
Store at room temperature away from heat and moisture. Track the dose indicator and discard the inhaler when it hits zero or three months after inserting a new cartridge, whichever comes first.
Which medicines or supplements can interact with Combivent
Nonselective beta-blockers may blunt albuterol’s effect; MAO inhibitors and tricyclic antidepressants can amplify cardiovascular effects; diuretics may increase the risk of low potassium; other anticholinergics can intensify dry mouth or urinary symptoms. Always share your full medication list with your clinician.
Can I overuse Combivent
Yes. Using it more often than prescribed can increase side effects and signal worsening COPD control; contact your clinician if you need it more frequently, as your maintenance regimen may need adjustment.
How do I know if Combivent is working for me
You should notice easier breathing, less wheeze, and improved exercise tolerance within minutes to an hour after use. If symptom relief is weak or short-lived, or you’re using it more often, discuss step-up therapy with your healthcare professional.
Is there a peanut or soy allergy warning with Combivent
The older aerosol formulation contained soya lecithin, but Combivent Respimat does not and does not carry a peanut/soy allergy warning. If you have any history of severe allergies, review ingredients with your pharmacist.
Can I drink alcohol while using Combivent
There is no direct interaction, but alcohol can worsen dizziness or increase heart rate, which may add to albuterol-related jitteriness. If you choose to drink, do so in moderation and avoid if you notice palpitations or lightheadedness.
Is Combivent safe during pregnancy
There are limited human data; inhaled bronchodilators are often used when benefits outweigh risks. If you’re pregnant or planning pregnancy, discuss the risk–benefit balance and consider whether your COPD action plan is optimal.
Can I use Combivent while breastfeeding
Systemic absorption of inhaled ipratropium is minimal, but small amounts of albuterol may be present in breast milk. Decide with your clinician by weighing maternal benefit and potential infant exposure; monitor the infant for irritability or poor feeding if concerned.
Should I stop Combivent before surgery or anesthesia
Do not stop bronchodilators without medical advice. Inform your surgical and anesthesia teams; they often recommend continuing inhaled therapy up to and including the day of surgery to keep airways open.
Is it safe to drive after using Combivent
Most people can drive, but if you experience dizziness, blurred vision from accidental eye exposure, or tremor, wait until you feel normal. Practice good inhaler technique to avoid ocular exposure.
What if I have heart disease or high blood pressure
Albuterol can increase heart rate and blood pressure in some users. If you have coronary disease, arrhythmias, or uncontrolled hypertension, use under close medical supervision and report palpitations, chest pain, or significant BP changes.
What if I have glaucoma, enlarged prostate, or urinary retention
Ipratropium’s anticholinergic effects can worsen narrow-angle glaucoma and urinary retention. Use with caution, avoid eye exposure, and contact your clinician promptly if you develop eye pain or difficulty urinating.
Will Combivent affect sports drug testing
Albuterol is permitted by many sporting bodies at limited inhaled doses, while ipratropium is generally allowed. Check the current rules (e.g., WADA) and keep prescriptions and dosing records.
How does Combivent compare with albuterol alone
Combivent pairs albuterol with ipratropium, often providing greater bronchodilation and symptom relief in COPD than albuterol alone. Albuterol alone acts faster but may not last as long or reduce symptoms as effectively in some patients.
How does Combivent compare with ipratropium (Atrovent) alone
Adding albuterol to ipratropium can improve airflow and relieve symptoms more than ipratropium alone, especially during acute bronchospasm. The combination targets two pathways for airway relaxation.
Combivent versus DuoNeb: what’s the difference
Both contain ipratropium and albuterol; Combivent Respimat is an inhaler, while DuoNeb is a nebulized solution. Nebulizers can be helpful in severe flares or for those who struggle with inhaler technique, but inhalers are more portable and often equally effective with correct use.
Combivent Respimat versus the old aerosol inhaler
The older chlorofluorocarbon-propelled aerosol is no longer marketed; Respimat delivers a slow-moving soft mist that can be easier to inhale. Respimat does not contain soy/peanut excipients associated with the old product.
Combivent versus long-acting LABA/LAMA inhalers like Anoro Ellipta
Combivent is short-acting and used for quick relief or scheduled QID dosing, while Anoro (umeclidinium/vilanterol) provides 24-hour maintenance bronchodilation. Many COPD plans use a LABA/LAMA daily, with short-acting agents like Combivent for breakthrough symptoms.
Combivent versus Spiriva (tiotropium)
Spiriva (tiotropium) is a long-acting muscarinic antagonist for once-daily maintenance, reducing exacerbations over time. Combivent is short-acting; it helps with immediate symptoms but does not replace the long-term benefits of tiotropium.
Combivent versus Stiolto Respimat (tiotropium/olodaterol)
Stiolto combines a LAMA and LABA for maintenance therapy in COPD with once-daily dosing. Combivent combines a SAMA with a SABA for short-term relief and is not a replacement for long-acting regimens in moderate to severe COPD.
Combivent versus Symbicort (budesonide/formoterol)
Symbicort contains an inhaled corticosteroid plus a LABA and is used as maintenance therapy; it addresses airway inflammation and provides long-acting bronchodilation. Combivent does not contain a steroid and is intended for short-acting bronchodilation.
Combivent versus Advair/Wixela (fluticasone/salmeterol)
Advair/Wixela is an ICS/LABA maintenance inhaler taken regularly to control chronic symptoms and reduce exacerbations. Combivent is for rapid symptom relief and scheduled short-acting use, not long-term inflammation control.
Combivent versus albuterol as a rescue during COPD flare-ups
Both can relieve acute bronchospasm; Combivent may offer greater and more sustained bronchodilation by adding ipratropium. Choice depends on your action plan, severity of symptoms, and clinician guidance.
Combivent versus nebulized treatments during severe symptoms
In severe exacerbations, nebulized ipratropium/albuterol (DuoNeb) may be used because it’s easier to inhale over several minutes. Outside of severe episodes, a properly used inhaler like Combivent Respimat provides similar bronchodilation with more convenience.
Combivent versus levalbuterol
Levalbuterol is a SABA similar to albuterol but contains only the R-enantiomer; some patients report fewer side effects, though evidence is mixed. Combivent provides dual-mechanism bronchodilation that may outperform a SABA alone in COPD.
Is there a generic alternative to Combivent
There is no direct generic for Combivent Respimat in many markets, but the combination is available as a nebulized generic (ipratropium/albuterol). Your clinician or pharmacist can review cost-effective options based on your insurance and inhaler technique.
When should I consider switching from Combivent to another therapy
If you have persistent daily symptoms, frequent rescue use, or repeated exacerbations, your clinician may escalate to long-acting bronchodilators (LABA/LAMA) and consider adding inhaled corticosteroids based on your exacerbation risk and eosinophil count. Combivent can remain as-needed for breakthrough symptoms.