Klin Farmakol Farm. 2010;24(2):75-79

Role of inhaled anticholinergics in treating chronic obstructive pulmonary disease (COPD)

Jaromír Musil
Pneumologická klinika Univerzity Karlovy a 2. lékařské fakulty a FN Motol, Praha

The cholinergic effect on the airways is mediated by muscarinic receptors in the target airway cells. The activation of these receptors in

bronchial smooth muscles initiates a cascade of biochemical events that result in bronchoconstriction. Muscarinic receptors also mediate

the secretory response to vagal nerve stimulation. Cholinergic agonists have a high secretory activity thereby stimulating the secretion

of mucus from the submucosal glands and epithelial goblet cells, the main sources of mucus in the peripheral airways.

Therefore, both short- and long-acting anticholinergics are of major significance in the treatment of COPD.

Keywords: COPD, cholinergic effect, anticholinergics

Published: July 1, 2010  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
Musil J. Role of inhaled anticholinergics in treating chronic obstructive pulmonary disease (COPD). Klin Farmakol Farm. 2010;24(2):75-79.
Download citation

References

  1. Musil J, Kos S, Vondra V, et al. Světová iniciativa o chronické obstrukční plicní nemoci: Světová strategie diagnostiky, léčby a prevence chronické obstrukční plicní nemoci. Vltavín, Praha 2007; 164 (překlad).
  2. Chapman KR. History of anticholinergic treatment in airways disease. In: Gross, NJ. Anticholinergic therapy in obstructive airways disease. Franklin Scientific Publications, London 1993; 9-17.
  3. Tramontana JA, Marderosian AH. Anti-asthmatic drugs as hallucinogens. Pennsylvania Medicine. 1967; 70: 58-60.
  4. McFadden ER, Jr. Inhaled aerosol bronchodilators. Baltimore, MD., Williams and Wilkins, 1986: 1-5.
  5. Gandevia B. Historical review of the use of parasympatholytic agents in the treatment of respiratory disorders. Postgraduate Medical Journal 1975; 5: 13-20.
  6. Barnes PJ. Muscarinic receptors in airways: recent developments. J. Appl. Physiol. 1990; 68: 1777-1785. Go to original source... Go to PubMed...
  7. Grandordy BM, Cuss FM, Sampson AS, et al. Phosphatidylinositol response to cholinergic agonists in airway smooth muscle: relationship to contraction and muscarinic receptor occupancy. J. Pharm. Exp. Therapy, 1986; 238: 273-279.
  8. Jones CA, Madison JM, Tom-May M, et al. Muscarinic cholinergic inhibition of adenylate cyclase in airway smooth muscle. Am. J. Physiol. 1987; 253: C97-C104. Go to original source... Go to PubMed...
  9. Tokuyama K, Kuro HP, Rohde JA. Neural control of goblet cell secretion in guinea pig airways. Am. J. Physiol. 1990; 259: L108-L115. Go to original source... Go to PubMed...
  10. Sant'Ambrogio G. Information arising from the tracheobronchial tree of mammals. Physiol. Rev. 1982; 62: 531-569. Go to original source... Go to PubMed...
  11. Barnes PJ. Theoretical aspects of anticholinergic treatment. In: Gross NJ. Anticholinergic therapy in obstructive airways disease. Franklin Scientific Publications, London, 1993: 88-104.
  12. Connoly CK. Adverse reaction to ipratropium bromide. Br. Med. J. 1982; 285: 934-935. Go to original source... Go to PubMed...
  13. Ashutosh K, Lang H. Comparison between long-term treatment of chronic bronchitic airway obstruction with ipratropium bromide and metaproterenol. Ann Allergy 1984; 53: 401-406.
  14. Rennard SI, Serby CW, Ghafouri M, et al. Extended therapy with ipratropium is associated with improved lung function in patients with COPD. A retrospective analysis of data from seven clinical trials. Chest 1996; 110: 62-67. Go to original source... Go to PubMed...
  15. O'Donnell DE, Lam M, Webb KA. Spirometric correlates of improvement in exercise performance after anticholinergic therapy in COPD.Am J Respir Crit Care Med 1999; 160: 542-549. Go to original source... Go to PubMed...
  16. Mahler DA, Donohue JF, Barbee RA, et al. Efficacy of salmeterol xinafoate in the treatment of COPD. Chest 1999; 115: 957-965. Go to original source... Go to PubMed...
  17. Dahl R, Greefhorst LA, Nowak D, et al. On behalf of the Formoterol in COPD I (FICOPD I) Study Group. Inhaled formoterol dry powder versus ipratropium bromide in COPD. Am J Respir Crit Care Med 2001; 164: 778-784. Go to original source... Go to PubMed...
  18. van Noord JA, de Munck DR, Bantje TA, et al. Long-term treatment of COPD with salmeterol and the additive effect of ipratropium. Eur Respir J 2000; 15: 878-885. Go to original source... Go to PubMed...
  19. Musil J, Vondra V, Kos S. Světová strategie diagnostiky, léčby a prevence chronické obstrukční plicní nemoci, Vltavín, 2001: 208 (překlad).
  20. Casaburi R, Mahler DA, Jones PW, et al. A long-term evaluation of once-daily inhaled tiotropium in chronic obstructive pulmonary disease. Eur Respir J 2002; 1: 217-224. Go to original source... Go to PubMed...
  21. Vincken W, van Noord A, Greefhorst APM, et al. Improved health outcomes in patients with COPD during 1 year treatment with tiotropium. Eur Respir J 2002; 19: 209-216. Go to original source... Go to PubMed...
  22. Johansson G, Lindberg A, Romberg K, et al. Bronchodilator efficacy of tiotropium in patients with mild to moderate COPD. Primary Care Resp J 2008; 17: 169-175. Go to original source... Go to PubMed...
  23. O´Donnell D, E, Fluege T, Gerken F, et al. Effects of tiotropium on lung hyperinflation, dyspnoea and exercise tolerance in COPD. Eur Resp. J 2004; 23: 832-840. Go to original source... Go to PubMed...
  24. Barr RG, Bourbeau J, Camargo CA, et al. Tiotropium for stable chronic obstructive pulmonary disease: a meta analysis. Thorax 2006; 61: 854-862. Go to original source... Go to PubMed...
  25. Rodrigo GJ, Nannini LJ. Tiotropium for the treatment of the stable chronic obstructive pulmonary disease: A systematic review with meta-analysis. Pulm Pharmacol Therap 2006; 2: 1-8.
  26. Tashkin D, Celli B, Senn S, et al. A 4-year trial of tiotropium in chronic obstructive pulmonary disease. NEJM 2008; 359: 1543-1554. Go to original source... Go to PubMed...
  27. Keam S, Ketings J, Gilliani M. Tiotropium bromide. A review of its use as maintenance therapy in patients with COPD. Treat Respir Med 2004; 3: 247-268. Go to original source... Go to PubMed...
  28. Pieper MP, Chaudhary NI, Park JE. Acetylcholine - induced proliferation of fibroblasts and myofibroblasts in vitro is inhibited by tiotropium bromide. Life Science 2007; 80: 3200-3205. Go to original source... Go to PubMed...
  29. Richter A, Anton SF, Koch P, et al. The impact of reducing dose frequency on health outcomes. Clin Ther 2003; 25: 2307-2335. Go to original source... Go to PubMed...
  30. Breekveldt-Postma NS, Koerselman J, Erkens JA, et al. Enhanced persistence with tiotropium compared with other respiratory drugs in COPD. Respir Med 2007; 101: 1398-1405. Go to original source... Go to PubMed...
  31. European Respiratory Society. Europen White Book: Huddersfield, European Respiratory Society Journals, Ltd, 2003.
  32. Niewoehner DE, Rice K, Pulson D, et al. Prevention of Exacerbations of Chronic Obstructive Pulmonary Disease with Tiotropium, a Once-Daily Inhaled Anticholinergic Bronchodilator A Randomized Trial Ann Intern Med 2005; 143: 317-326. Go to original source... Go to PubMed...
  33. Dusser D, Bravo ML, Iaconi P, et al. The effect of tiotropium on exacerbations and airflow in patients with COPD Eur Resp J 2006; 27: 547-555. Go to original source... Go to PubMed...
  34. Barnes PJ. New development in anticholinergic drugs. Eur Respir Rev, 1996; 6: 290-294. Go to original source...




Clinical Pharmacology and Pharmacy

Madam, Sir,
please be aware that the website on which you intend to enter, not the general public because it contains technical information about medicines, including advertisements relating to medicinal products. This information and communication professionals are solely under §2 of the Act n.40/1995 Coll. Is active persons authorized to prescribe or supply (hereinafter expert).
Take note that if you are not an expert, you run the risk of danger to their health or the health of other persons, if you the obtained information improperly understood or interpreted, and especially advertising which may be part of this site, or whether you used it for self-diagnosis or medical treatment, whether in relation to each other in person or in relation to others.

I declare:

  1. that I have met the above instruction
  2. I'm an expert within the meaning of the Act n.40/1995 Coll. the regulation of advertising, as amended, and I am aware of the risks that would be a person other than the expert input to these sites exhibited


No

Yes

If your statement is not true, please be aware
that brings the risk of danger to their health or the health of others.