Ipratropium bromide is an anticholinergic agent that is commonly used in the intensive care unit (ICU) and in the treatment of asthma and chronic obstructive airways disease (COPD). Ipratropium is a competitive muscarinic acetylcholine receptor antagonist that when given intravenously is most potent at the inhibition of bronchial receptors. When given by the inhaled route, even in high dosage, the systemic effects, such as salivary, cardiac, ocular, and urinary effects, are negligible. It produces a dose-related inhibition of both substance-induced and exercised-induced bronchoconstriction. It is a potent bronchodilator in patients with COPD but is less potent in patients with asthma that is responsive to beta-2 agonists. In patients with asthma alone, the combination of ipratropium and a beta-2 agonist may be synergistic, but often beta-2 agonism may be a good solo-agent treatment. Other treatments for COPD in addition to anticholinergics and beta-2 agonists are theophylline and corticosteroids.