Which drug is primarily used for severe exacerbations when albuterol is insufficient?

Ipratropium bromide is often used in combination with other bronchodilators for the management of severe exacerbations because it works through a different mechanism than albuterol. While albuterol is a beta-agonist that relaxes bronchial smooth muscle, ipratropium is an anticholinergic agent that helps to reduce bronchial secretions and further dilate the airways. In cases where albuterol alone is not effective, adding ipratropium can provide additional relief by opening the airways through a complementary action.

Using ipratropium during a severe exacerbation can enhance bronchodilation when patients are experiencing significant respiratory distress. This combination therapy is particularly useful in the management of conditions such as chronic obstructive pulmonary disease (COPD) and asthma exacerbations.

Other options like levalbuterol, racemic epinephrine, and corticosteroids have their specific roles but may not be the primary choice when albuterol is insufficient during a severe exacerbation. Levalbuterol, for instance, is a stereoisomer of albuterol and may still have limitations similar to albuterol in acute situations. Racemic epinephrine is generally used for stridor or croup rather than asthma exacerbations. Lastly, corticosteroids are