Muscarinic Antagonists
In asthma, muscarinic antagonists (both short- and long-acting) were historically considered less effective than β2-agonists - Alberto Papi
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Antimuscarinics For Respiratory Diseases
Anticholinergic alkaloids have been used for thousands of years for the relief of bronchoconstriction...
Short-acting antimuscarinic agents may be effective alone or in combination with short-acting beta agonists for the relief of acute symptoms. Long-acting antimuscarinic agents have emerged as potentially useful in the long-term treatment of difficult-to-control asthma.
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Anticholinergic agents for chronic asthma in adults
Overall this review provides no justification for routinely introducing anticholinergics as part of add-on treatment for patients whose asthma is not well controlled on standard therapies. This does not exclude the possibility that there may be a sub-group of patients who derive some benefit and a trial of treatment in individual patients may still be justified. The role of long term anticholinergics such as tiotropium bromide has yet to be established in patients with asthma and any future trials might draw on the messages derived from this review.
Articles of Interest
Anticholinergics/Antimuscarinic Drugs in Asthma
Short-acting antimuscarinic agents may be effective alone or in combination with short-acting beta agonists for the relief of acute symptoms. Long-acting antimuscarinic agents have emerged as potentially useful in the long-term treatment of difficult-to-control asthma.
Bronchodilators - Antimuscarinics (LAMA)
The action of LAMAs has maximal effect 30-60 minutes after use, they have no immediate effect. They are used with other inhaled medications.
How to Use Your Combivent Respimat Inhaler (ipratropium/albuterol)
Combivent Respimat is a short- acting anticholinergic and short-acting beta-2 agonist and will begin working within minutes. You can expect to breathe easier and it opens your small and large airways.
Inhaled long-acting muscarinic antagonists in asthma – A narrative review
In asthma, muscarinic antagonists (both short- and long-acting) were historically considered less effective than β2-agonists; only relatively recently have studies been conducted to evaluate the efficacy of LAMAs, as add-on to either inhaled corticosteroid (ICS) monotherapy or ICS/long-acting β2-agonist (LABA) combinations.
Optimizing asthma management: Role of long-acting muscarinic antagonists
Patients with asthma who are suboptimally responsive to inhaled corticosteroids (ICS) and long-acting β2-agonists (LABAs) are frequently exposed to oral corticosteroids and high-dose ICS, which can lead to significant side effects. Long-acting muscarinic antagonists (LAMAs) have demonstrated efficacy and safety in a subset of these patients.
Renewed perspective on efficacy and safety of inhaled muscarinic antagonists as asthma management therapies
The absence of tolerance to ipratropium bromide suggest muscarinic antagonists may be safer alternatives for regular use compared to beta 2-agonists. This finding is contradicted by the observed increase in allergen responsiveness following regular use of tiotropium.
Resources
List of Anticholinergic bronchodilators
Anticholinergic bronchodilators (or muscarinic receptor antagonists) block the parasympathetic nerve reflexes that cause the airways to constrict, so allow the air passages to remain open. Muscarinic receptor antagonists bind to muscarinic receptors and inhibit acetylcholine mediated bronchospasm.
Ipratropium (Atrovent)
Ipratropium is a bronchodilator medication that dilates the airways of the lungs. Ipratropium has been approved by the US Food and Drug Administration (FDA) for treating bronchospasms associated with chronic obstructive pulmonary disease (COPD), including emphysema and chronic bronchitis. Maintenance therapy with ipratropium has established benefits in the treatment of COPD.
Trelegy
Trelegy contains an ICS, an anticholinergic, and a LABA.
