What is the bronchodilator of choice for patients taking propranolol?

In patients taking propranolol, the bronchodilator of choice is ipratropium. Propranolol is a non-selective beta-blocker that can potentially exacerbate bronchoconstriction in patients with reactive airway diseases like asthma or COPD, as it blocks β2-adrenergic receptors that mediate bronchodilation.

Ipratropium, as an anticholinergic bronchodilator, works through a different mechanism by blocking muscarinic receptors in the airway smooth muscle, leading to bronchodilation without the risk of β-receptor antagonism, which is particularly important for patients receiving propranolol. This makes ipratropium a safer choice for these individuals, helping to avoid potential exacerbation of their respiratory condition.

Other options like albuterol, while effective as a bronchodilator, act primarily on β2 receptors and may not be suitable for patients on propranolol due to the risk of counteracting the effects of the beta-blocker. Theophylline's action involves multiple pathways and can also be less predictable in these patients, while montelukast is a leukotriene receptor antagonist that does not provide the immediate bronchodilation needed in acute situations. Therefore, ipratropium is favored for