The development of anticholinergics in the management of COPD

Jane E Scullion

University Hospitals of Leicester Glenfield Site, Institute for Lung Health, Leicester; Department of General Practice and Primary Care, Aberdeen University, Aberdeen, UK

Abstract: Anticholinergics have been used to treat obstructive respiratory disease for many years from historical preparations of the deadly nightshade genus, to the more recent developments of ipratropium, oxitropium, and tiotropium. The medical treatment of airways obstruction has focused on achieving maximal airway function through bronchodilators. Of the two main bronchodilators, beta2-agonists are often the first treatment choice although there is evidence of equivalence and some suggestions of the superiority of anticholinergics in chronic obstructive pulmonary disease (COPD). The following review looks at the background of anticholinergics, their pharmacological properties, and the evidence for use with suggestions for their place in the treatment of COPD.

Keywords: anticholinergics, ipratropium, oxitropium, tiotropium, breathlessness, exacerbations, health related quality of life, exercise tolerance