title: Potential for long-acting muscarinic antagonists in chronic obstructive pulmonary disease.
abstract: BACKGROUND
  The prevention and relief of symptoms by regular use of bronchodilators is central to the pharmacological management of chronic obstructive pulmonary disease (COPD).
  
  
  METHODS
  The aim of this article is to review the effects of inhaled muscarinic antagonists in the treatment of stable COPD.
  
  
  RESULTS
  An update of the clinical studies performed with the long-acting inhaled muscarinic antagonist (LAMA) tiotropium bromide in patients with COPD is given. In recent years, combinations of a LAMA and a long-acting inhaled beta2-agonist (LABA), and 'triple therapy' consisting of a LAMA, a LABA, and an inhaled steroid are being developed. Issues of safety of inhaled anticholinergics in COPD are discussed and a short overview of new LAMAs being developed for COPD is given.
  
  
  CONCLUSIONS
  The importance of anticholinergic drug treatment in COPD was largely advanced by the development of the first LAMA, tiotropium bromide. The vast experience obtained with tiotropium bromide has paved the way for new LAMAs such as aclidinium bromide and glycopyrrolate (NVA-237).
authors.affiliation: Ghent University Hospital, Department of Respiratory Medicine, De Pintelaan 185, Gent 9000, Belgium. guy.joos@ugent.be
authors.forename: Guy F
authors.initials: GF
authors.lastname: Joos
mesh_terms: D000280:Administration, Inhalation; D000318:Adrenergic beta-Agonists / Q000008:administration & dosage; D000730:Androstadienes / Q000008:administration & dosage; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology; D002986:Clinical Trials as Topic; D003692:Delayed-Action Preparations / Q000008:administration & dosage* / Q000009:adverse effects / Q000494:pharmacology; D004353:Drug Evaluation, Preclinical; D004359:Drug Therapy, Combination / Q000009:adverse effects; D015507:Drugs, Investigational; D000068298:Fluticasone; D006801:Humans; D018727:Muscarinic Antagonists / Q000008:administration & dosage* / Q000009:adverse effects / Q000494:pharmacology; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy*; D011976:Receptors, Muscarinic / Q000187:drug effects; D012602:Scopolamine Derivatives / Q000008:administration & dosage* / Q000009:adverse effects / Q000494:pharmacology; D000069447:Tiotropium Bromide
chemical_list: D000318:Adrenergic beta-Agonists; D000730:Androstadienes; D001993:Bronchodilator Agents; D003692:Delayed-Action Preparations; D015507:Drugs, Investigational; D018727:Muscarinic Antagonists; D011976:Receptors, Muscarinic; D012602:Scopolamine Derivatives; D000068298:Fluticasone; D000069447:Tiotropium Bromide