Which medications in the drug class Long-Acting Muscarinic Agents are used in the treatment of Hypoventilation Syndromes?

Updated: Jul 22, 2021
  • Author: Jazeela Fayyaz, DO; Chief Editor: Guy W Soo Hoo, MD, MPH  more...
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Long-Acting Muscarinic Agents

These medications interrupt vagal-induced bronchoconstriction, and are also known as long-acting anticholinergics. These are mainly used in COPD.

Tiotropium (Spiriva HandiHaler, Spiriva Respimat)

Tiotropium, a bronchodilator similar to ipratropium, is a once-daily, long-acting anticholinergic medication that has been shown to have significant clinical benefit. A quaternary ammonium compound, it elicits anticholinergic/antimuscarinic effects, with inhibitory effects on M3 receptors on airway smooth muscles, leading to bronchodilation. Tiotropium is the only long-acting muscarinic agent available at this time and has become a first-line therapy in patients with persistent symptoms. Tiotropium is more effective than salmeterol in preventing exacerbations.

Umeclidinium bromide (Incruse Ellipta)

Umeclidinium bromide is a long-acting muscarinic antagonist (LAMA) inhalation powder, often referred to as an anticholinergic. It blocks action of acetylcholine at muscarinic receptors (M1 to M5) in the bronchial airways (M3) by preventing an increase in intracellular calcium concentration, leading to relaxation of airway smooth muscle, improved lung function, and decreased mucus secretion. Umeclidinium dissociates slowly from M3 muscarinic receptors extending its duration of action. It is indicated for the long-term, once-daily, maintenance treatment of airflow obstruction in patients with COPD), including chronic bronchitis and/or emphysema.

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