title: Muscarinic Receptor Antagonists.
abstract: Parasympathetic activity is increased in patients with chronic obstructive pulmonary disease (COPD) and asthma and appears to be the major reversible component of airway obstruction. Therefore, treatment with muscarinic receptor antagonists is an effective bronchodilator therapy in COPD and also in asthmatic patients. In recent years, the accumulating evidence that the cholinergic system controls not only contraction by airway smooth muscle but also the functions of inflammatory cells and airway epithelial cells has suggested that muscarinic receptor antagonists could exert other effects that may be of clinical relevance when we must treat a patient suffering from COPD or asthma. There are currently six muscarinic receptor antagonists licenced for use in the treatment of COPD, the short-acting muscarinic receptor antagonists (SAMAs) ipratropium bromide and oxitropium bromide and the long-acting muscarinic receptor antagonists (LAMAs) aclidinium bromide, tiotropium bromide, glycopyrronium bromide and umeclidinium bromide. Concerns have been raised about possible associations of muscarinic receptor antagonists with cardiovascular safety, but the most advanced compounds seem to have an improved safety profile. Further beneficial effects of SAMAs and LAMAs are seen when added to existing treatments, including LABAs, inhaled corticosteroids and phosphodiesterase 4 inhibitors. The importance of tiotropium bromide in the maintenance treatment of COPD, and likely in asthma, has spurred further research to identify new LAMAs. There are a number of molecules that are being identified, but only few have reached the clinical development.
authors: Department of Experimental Medicine, Unit of Pharmacology, Second University of Naples, Naples, Italy.
authors: Maria Gabriella
authors: MG
authors: Matera
authors: Division of Respiratory Medicine, University Hospital Tor Vergata, Rome, Italy. mario.cazzola@uniroma2.it.
authors: Mario
authors: M
authors: Cazzola
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D058666:Adrenergic beta-2 Receptor Agonists / Q000627:therapeutic use; D000818:Animals; D001249:Asthma / Q000188:drug therapy*; D055808:Drug Discovery; D004359:Drug Therapy, Combination; D006801:Humans; D018727:Muscarinic Antagonists / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D058988:Phosphodiesterase 4 Inhibitors / Q000627:therapeutic use; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy*
chemical_list: D000305:Adrenal Cortex Hormones; D058666:Adrenergic beta-2 Receptor Agonists; D018727:Muscarinic Antagonists; D058988:Phosphodiesterase 4 Inhibitors
keywords: Antimuscarinic agents; Fixed-dose combinations; Inhaled corticosteroids; β2-agonists