Hey, Fred???

"The active ingredient in ATROVENT HFA Inhalation Aerosol is
ipratropium bromide. It is an anticholinergic bronchodilator
chemically described as 8-Azoniabicyclo [3.2.1] octane, 3-(3-hydroxy-1-
oxo-2-phenylpropoxy)-8-methyl-8-(1-methylethyl)-, bromide,
monohydrate, (endo, syn ): a synthetic quaternary ammonium compound,
chemically related to atropine."

Quaternary ammonium compounds.

That's the category in which preservatives like Benzalkonium Chloride
live.  It's the same category of drug that GIVES RISE TO the "don't
use nose spray for more than 4 or 5 days" caveat.

I'm simply not in the position to do the research at the moment (not
when the Mayo is pushing hard for me to do 4 wks or IV steroids for
something where they have ZERO efficacy data, that is....), but ... if
it were me .... I'd look and think long and hard before I hung my hat
on this one for too long.

BAK DEFINITELY is toxic to mucous membranes.  I'd be awfully hesitant
to assume that Ipratropium bromide is NOT.

My eyes (and, it's presumed, my sinuses) are irreparably damaged from
long-term use of eye drops preserved with a quaternary ammonium
(obviously, what goes in the eyes, gets in the sinuses).  I learned a
lot about this one the hard way.  I would hate for the same to happen
to you.

In the beginning, my sense of relief from my particular (really
elusive and disabling) eye problem was similar to yours, but ... over
time ... I paid an incalculable price.

Do some research.  Seriously.