- Make you feel better
- Allow you to participate more in life
- Help you stay active
- Prevent and treat complications
- Improve your overall quality of life
The goals of therapy for chronic obstructive pulmonary disease (COPD) are to prevent disease progression, relieve symptoms, improve health status, prevent and treat complications and exacerbations, reduce morbidity, and prevent or minimize adverse effects from treatment.
Combination Therapy
Anticholinergics and β-agonists reduce bronchoconstriction through different mechanisms, and there is a long history of combination therapy with short-acting agents in these classes for chronic obstructive pulmonary disease
Anticholinergic treatment in airways diseases
The prevalence of chronic airways diseases such as chronic obstructive pulmonary disease and asthma is increasing. They lead to symptoms such as a cough and shortness of breath, partially through bronchoconstriction. Inhaled anticholinergics are one of a number of treatments designed to treat bronchoconstriction in airways disease. Both short-acting and long-acting agents are now available and this review highlights their efficacy and adverse event profile in chronic airways diseases.
Short-acting Anticholinergic Drugs in Asthma
Ipratropium bromide was introduced into the management of obstructive airway diseases. Since the introduction of this short-acting rapid-onset bronchodilator in clinical practice, several studies have been performed in order to assess the efficacy of this compound in asthma and COPD, in comparison with short-acting β2-agonsists.
In earlier studies, small groups of asthmatic subjects were studied, using similar protocols single doses, crossover study, with forced expiratory volume in 1-FEV1 measured up to 6 h after dosing. In almost all studies, both in single and increasing doses, determined a greater bronchodilation than ipratropium bromide in asthmatic subjects; whereas in normal subjects or in patients with COPD, both drugs determined a similar bronchodilation, All these data, together with the similar efficacy of salbutamol and ipratropium in COPD patients, led to the general opinion that in asthma, cholinergic tone is less important than inflammatory mediator-induced smooth muscle contraction and, therefore, anticholinergic drugs were considered to represent the second choice in the bronchodilator treatment in asthma.
Tiotropium is the first long-acting anticholinergic drug that has been developed and approved for the management of stable COPD. The efficacy and safety of tiotropium in all stages of COPD severity has been largely demonstrated by several studies. Despite a large amount of data available on tiotropium in COPD, it is only recently that studies have been conducted in asthma. The decision of not promoting tiotropium in asthma was derived from the opinion that in COPD, and not in asthma, the cholinergic tone played a more relevant role on the airway calibre than the β2-agonist relaxation.
Long-term clinical outcomes associated with β-agonist and anticholinergic bronchodilator use in patients with chronic obstructive pulmonary disease (COPD). Pooled data from randomized placebo-controlled trials of at least three months duration were used to evaluate the risk for COPD hospitalizations, respiratory mortality, and total mortality. The results show that anticholinergic use is associated with a 30% reduction in COPD hospitalizations, a 70% reduction in respiratory mortality, and without a significant effect on total mortality. In contrast, β-agonist use had no effect on COPD hospitalizations and was associated with a two-fold increased risk for respiratory death compared with placebo. When the two bronchodilators were directly compared with each other, β-agonists were associated with a two-fold increased risk for COPD hospitalization and a five-fold increased risk for total mortality compared with anticholinergics. When β-agonists were added to either anticholinergic use or inhaled corticosteroid use alone, there was no significant improvement in any long-term clinical outcome. These results indicate that anticholinergics should be the bronchodilator of choice in COPD.
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