The role of anticholinergics in chronic obstructive pulmonary disease

Anticholinergics are the bronchodilators of choice in the management of chronic obstructive pulmonary disease (COPD). They work by blocking muscarinic receptors in airway smooth muscle. Cholinergic tone appears to be the only reversible component of COPD. With the discovery of different muscarinic receptor subtypes, the development of m ore selective anticholinergics is possible. A major advance in this therapeutic area has been the discovery. of tiotropium bromide, which has kinetic selectivity for M-3 receptors as well as a duration of action of >24 hours. Once-daily administration of tiotropium is Well tolerated-and has shown significant advantages over ipratropium bromide, given 4 times daily, in the control of COPID.