How Do Respiratory Anticholinergics Work?

Respiratoryanticholinergics are medications prescribed to treatchronic obstructive pulmonary disease(COPD) andasthma. Respiratory anticholinergics makebreathingeasier by relaxing the smooth muscles of bronchialtubes, improving lung function, and reducingmucussecretionintherespiratory system.

Some of the respiratory anticholinergics are combined with other medications that reduce hypersensitivity reaction in the respiratory system and reduceinflammation. Anticholinergics work by blocking the activity ofacetylcholine, aneurotransmitterthatnerveendings secrete to make muscles contract.

Acetylcholine binds toproteinmolecules known as muscarinic receptors on the surface ofmusclecells to make them contract. Acetylcholine also stimulates muscarinic receptors onexocrine glandcells to secrete fluids such as mucus,saliva, tears, andsweat.

Respiratory anticholinergics are long-acting muscarinic antagonists (LAMA), which relaxairwaysmooth muscles and reduce mucus secretion by blocking muscarinic receptors on the bronchial smooth muscles and theexocrineglandcells in the bronchial passage.

Other medications combined with anticholinergics include:

• Long-acting beta-2 agonists (LABAs): LABAs enhance the activity of beta-2 adrenergic receptors which are stimulated byepinephrine, a naturalhormone在体内。beta 2受体的刺激results inintracellularaction that relaxes bronchial muscles and inhibits hypersensitivity reaction from mast cells, a type ofimmunecells that initiate allergic reactions.
• Corticosteroids: Corticosteroids are powerfulanti-inflammatory agents used tocontrolinflammation.

Respiratory anticholinergics are orally inhaled in the form of powders, aerosolized tiny particles or droplets, or solutions nebulized into a fine mist. Many types of inhalation devices such as metered dose inhalers and nebulizers are available.

Respiratory anticholinergics are used to treat the following conditions:

FDA-approved:

• Long term maintenance treatment ofchronicobstructivepulmonarydiseases including:
  • Chronic bronchitis
  • Emphysema
  • Bronchospasm
• Long term maintenance treatment of asthma, an inflammatory bronchialcondition

Off-Label:

• Acuteasthmaexacerbation

Orphan designation:

• Cystic fibrosis, an inherited disorder that damages thelungsand thedigestive system

Side effects of respiratory anticholinergics may include the following:

• Headache
• Nasopharyngitis (inflammation ofnoseandthroat)
• Upper respiratory tractinfection
• COPD exacerbation
• Bronchitis(inflammation of bronchial passage)
• Sinusitis(inflammation of the sinuses)
• Rhinitis(inflammation of thenasal passage)
• Pharyngitis(throat inflammation)
• Laryngitis(inflammation of thelarynx)
• Oropharyngealpain(mouthand throat pain)
• Dyspnea(shortness of breath)
• Pneumonia
• Cough
• Dryness and irritation in the throat
• Paradoxical bronchospasm
• Urinary tract infection
• Urinaryretention
• Dysuria(painful urination)
• Diarrhea
• Dyspepsia(indigestion)
• Abdominal pain
• Constipation
• Nausea
• Vomiting
• Gastroesophageal refluxdisease(GERD)
• Gastroenteritis(inflammation of thegastrointestinal tract)
• Toothabscessandtoothache
• Angina pectoris(chest paindue to coronaryheart disease)
• Hypotension(low blood pressure)
• Cardiacarrhythmias (irregularheartrhythm andheart rate)
• Tachycardia(rapid heartbeat)
• Palpitations
• Atrial fibrillation(irregular and rapid heart rate with theatriaout of synchronization with theventricles)
• Supraventricular tachycardia(rapid heart rate beginning above the ventricles)
• Ventricularand supraventricular extrasystoles (extra heartbeats)
• Myocardial infarction(heart attack)
• Nonspecificchestpain
• Musculoskeletal chest pain
• Chest discomfort
• Back pain
• Neck pain
• Arthralgia(jointpain)
• Legpain
• Skeletalpain
• Myalgia(muscle pain)
• Muscle spasms
• Pain in extremities
• Paresthesia(pricklingsensation)
• Tremor
• Influenzaorflu-like symptoms
• Fatigue
• Asthenia(weakness)
• Dizziness
• Fall
• Contusion
• Anxiety
• Agitation
• Restlessness
• Depression
• Sleepdisturbance
• Insomnia
• Dehydration
• Dry mouth
• Mouthedema
• Stomatitis (inflammation and soreness inside the mouth)
• Glossitis(tongueinflammation)
• Oral candidiasis(Candida infection)
• Dysgeusia(tastedisorder)
• Dysphonia(hoarseness)
• Eyepain
• Cataract
• Conjunctivitis(inflammation ofconjunctiva,membraneon the whites of the eyes and the inner surface of eyelids)
• Conjunctivalhyperemia (dilationand redness ofbloodvessels in the conjunctiva)
• Blurred vision
• Halo vision
• Cornealedema
• Mydriasis(dilation of pupils)
• Increasedintraocular pressure
• Glaucoma(aprogressivedisease that damages theoptic nerve)
• Narrow-angle glaucoma (a type of glaucoma in which the fluid drainage angle in the eye becomes narrow and impairs drainage)
• Epistaxis(nasalbleeding)
• Hypersensitivity reactions such as:
  • Rash
  • Urticaria(hives)
  • Pruritus(itching)
  • Angioedema(swelling in thetissueunder theskinormucousmembranes)
  • Anaphylaxis(severeallergic reaction)
• Edema
• Herpes zoster
• Infections
• Candidiasis(Candida albicansfungalinfection)
• Hypercholesterolemia(highcholesterolin the blood)
• Hyperglycemia(highglucoselevels in the blood)

Information contained herein is not intended to cover all possible side effects, precautions, warnings, drug interactions, allergic reactions, or adverse effects. Check with yourdoctororpharmacist为了确保这些药物时不造成任何伤害n you take them along with other medicines. Never stop taking yourmedicationand never change your dose or frequency without consulting your doctor.

Genericand brand names of respiratoryanticholinergicdrugs include:

• aclidinium
• Anoro Ellipta
• Atrovent HFA
• Bevespi Aerosphere
• glycopyrrolate inhaled
• glycopyrrolateinhaled/formoterol
• Incruse Ellipta
• ipratropium
• Lonhala Magnair
• SpirivaHandiHaler
• Spiriva Respimat
• tiotropium
• Trelegy Ellipta
• Tudorza Pressair
• umeclidinium bromide
• umeclidinium bromide/vilanterol inhaled
• umeclidinium bromide/vilanterol inhaled/fluticasone furoate inhaled