title: Muscarinic receptor antagonists for the treatment of chronic obstructive pulmonary disease.
abstract: BACKGROUND
  Long-acting muscarinic receptor antagonists (LAMAs) are central to the treatment of chronic obstructive pulmonary disease (COPD) because of the important role of the cholinergic system in the pathophysiology of this disorder.
  
  
  METHODS
  LAMAs show clinically meaningful effects in lung function and other important supportive outcomes, such as exacerbations, health-related quality of life, dyspnea, rescue medication use and nighttime/early morning symptoms, and are safe. Muscarinic receptor antagonists could exert other useful actions such as the anti-inflammatory, anti-remodeling, mucus-modifying, and anti-cough effects. Concerns have been raised about possible associations of muscarinic receptor antagonists with cardiovascular morbidity and mortality. Muscarinic receptor antagonists can be combined with long-acting β2-agonists (LABAs), inhaled corticosteroids (ICSs) and LABA + ICS. There are number of LAMAs that are being identified but only few have reached the clinical development. Fixed-dose combination formulations of both novel and established LAMAs with LABAs are being developed.
  
  
  CONCLUSIONS
  There are important questions concerning the use of LAMAs in the treatment of patients suffering from stable COPD that need conclusive answers.
authors.affiliation: Second University, Department of Experimental Medicine , Via Santa Maria di Costantinopoli 16, 80138 Naples , Italy mariagabriella.matera@unina2.it.
authors.forename: Maria Gabriella
authors.initials: MG
authors.lastname: Matera
authors.forename: Paola
authors.initials: P
authors.lastname: Rogliani
authors.forename: Mario
authors.initials: M
authors.lastname: Cazzola
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D058666:Adrenergic beta-2 Receptor Agonists / Q000627:therapeutic use; D000818:Animals; D000893:Anti-Inflammatory Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000996:Antitussive Agents / Q000009:adverse effects / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D006801:Humans; D008168:Lung / Q000187:drug effects / Q000473:pathology; D018727:Muscarinic Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000473:pathology
chemical_list: D000305:Adrenal Cortex Hormones; D058666:Adrenergic beta-2 Receptor Agonists; D000893:Anti-Inflammatory Agents; D000996:Antitussive Agents; D018727:Muscarinic Antagonists