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Anticholinergic Medications

Description
Anticholinergic medications like atropine have been used to treat asthma for centuries. Although this type of medication fell into disfavor in past years, it is currently regaining popularity among asthma specialists. Not only have the anti-asthma effects of atropine been rediscovered, but new medications with effects similar to those of atropine have been recently introduced. These new medications are now used for bronchitis and emphysema. Their use for treatment of asthma is increasing even though they are not currently FDA approved for this specific disease.

The effect of anticholinergic medications appears to come from their ability to interfere with vagal nerve pathways that affect airway constriction. These medications may be particularly helpful when physical stress causes increased vagal nerve stimulation that could result in bronchospasm. Certain types of asthma may respond to this form of therapy. Currently The Asthma Center specialists recommend this therapy if you do not have an adequate response to sympathomimetic inhalers.

Types and Use
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Brand Name	Concentration	Active Ingredient	Total Usual Daily Adult Dose
Atrovent®	MDI: 18mcg/puff, 200 puffs/canister Nebulizer Solution: 0.5mg/2.5mL  (0.02% vial)	ipratropium bromide	MDI: 2 - 3 puffs every 6 hours, not to exceed 12 puffs/24 hours Nebulizer: 1 vial every 6 - 8 hours
Combivent®	MDI: 18mcg (ipratropium) and 103mcg  (albuterol)/puff 200 puffs/canister	ipratropium bromide  and albuterol sulfate	2 puffs 4 times per day, not to exceed 12 puffs/24 hours
DuoNeb™	Nebulizer Solution:  0.5mg (ipratropium) and 2.5mg (albuterol)/unit dose	ipratropium bromide and albuterol sulfate	1 unit dose 4 times per day
Spiriva® HandiHaler®	18 mcg/HandiHaler®  capsule	tiotropium bromide	1 capsule/inhalation once a day

Note: MDI = metered-dose inhaler; mcg = microgram; mg = milligram; mL = milliliter

Risks and Precautions
The possible side effects of atropine and to a lesser extent ipratropium bromide (Atrovent®), tiotropium bromide (Spiriva®) and glycopyrrolate (Robinul®) include: dry mouth, blurring of vision, racing heart and urinary retention if an enlarged prostate is present. Older adults are more sensitive to atropine side effects and may note flushing or psychological disturbances. These side effects are all reversible.