What is the role of anticholinergics in the treatment of chronic obstructive pulmonary disease (COPD)?

Updated: Nov 13, 2020
  • Author: Paul Kleinschmidt, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Anticholinergics have an important role in the acute treatment of COPD exacerbations. The anticholinergics reduce airway tone and improve expiratory flow limitation, primarily by blocking parasympathetic activity in the large and medium-sized airways. They also block the release of acetylcholine, which has been linked to increased bronchial smooth muscle tone and mucus hypersecretion.

These are not as effective as beta-agonists in acute attacks, but they have synergistic properties with the beta-agonists, and the combination of both agents is superior to either by themselves. They act by antagonizing the vagal innervation of the tracheobronchial tree. Vagal tone can be increased by as much as 50% in patients with COPD.

Anticholinergic agents include short-acting agents appropriate for management of acute exacerbations (eg, ipratropium) and long-acting agents (eg, tiotropium, aclidinium, and umeclidinium).

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