Anticholinergics in the treatment of chronic obstructive pulmonary disease.
Chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity and mortality in the world. In the majority of cases, the disease is the result of years of cigarette smoking. Contributing factors leading to bronchial obstruction in COPD include mucus hypersecretion and an increase in bronchial muscle tone, which is triggered mainly by cholinergic mechanisms. Anticholinergic bronchodilators reduce vagal cholinergic tone, the main reversible component of COPD; hence they are the first-line treatment for bronchial obstruction in COPD. In addition to improving lung function, anticholinergics improve dyspnea, quality of life and exercise tolerance, and they reduce exacerbations. When compared with other bronchodilators, anticholinergics show at least equivalent bronchodilator potency, but with fewer side effects. In addition, due to their unique site of action, anticholinergics can be effectively combined with other bronchodilators. The introduction of new, long-acting anticholinergics is a promising addition to the treatment of COPD and is expected to lead to improved treatment outcomes and improved patient compliance.
Beeh
Kai-Michael
KM
Pulmonary Division, 3rd Medical Department, University Hospital Mainz, Germany. k.beeh@3-med.klinik.uni-mainz.de
Welte
Tobias
T
Buhl
Roland
R
D000318:Adrenergic beta-Agonists / Q000494:pharmacology / Q000627:therapeutic use; D018680:Cholinergic Antagonists / Q000494:pharmacology* / Q000627:therapeutic use*; D006801:Humans; D009241:Ipratropium / Q000494:pharmacology / Q000627:therapeutic use; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy*; D012602:Scopolamine Derivatives / Q000494:pharmacology / Q000627:therapeutic use; D000069447:Tiotropium Bromide
D000318:Adrenergic beta-Agonists; D018680:Cholinergic Antagonists; D012602:Scopolamine Derivatives; C017590:oxitropium; D009241:Ipratropium; D000069447:Tiotropium Bromide