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Role of anticholinergic therapy in COPD

Section Editor
James K Stoller, MD, MS
Deputy Editor
Helen Hollingsworth, MD


The chronic obstructive airway diseases are a group of lung diseases that share the common pathophysiologic property of chronic persistent airflow obstruction. These diseases include chronic bronchitis, emphysema, bronchiectasis, cystic fibrosis, bronchiolitis obliterans, and asthma. By virtue of common usage, however, chronic obstructive pulmonary disease (COPD) has come to refer specifically to chronic bronchitis and emphysema.

Primary therapy for COPD is directed at reducing airways resistance. To the extent that bronchial smooth muscle constriction and airway inflammation and mucous plugging contribute to airflow obstruction, bronchodilators (along with smoking cessation) can improve lung function. By comparison, there is currently no effective therapy for the irreversible airflow obstruction that results from airway obliteration, peribronchial and peribronchiolar fibrosis, and loss of elastic recoil.

Both anticholinergic agents and beta adrenergic agonists are effective in reversing the reversible part of airway obstruction. However, inhaled ipratropium bromide is preferred over beta-2 agonists by many as the bronchodilator of choice in COPD for the following reasons:

Its minimal cardiac stimulatory effects compared to those of beta-agonists

Its greater effectiveness than either beta-agonist or methylxanthine bronchodilators in most studies of patients with COPD

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Literature review current through: Nov 2017. | This topic last updated: Sep 18, 2017.
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