Anticholinergic agents, derived from plant alkaloids, have been used for medicinal purposes for hundreds of years. They were introduced to Western medicine by the British in the 1800s, and gained wide popularity as inhaled agents (smoked through pipes or cigarets) for the therapy of asthma and bronchitis during the 1800s and early 1900s. As adrenergic agents were developed their use declined. However, over the past three decades, there has been a renaissance in the use of anticholinergic agents for respiratory disorders. There are two reasons for their reintroduction into our therapeutic armamentarium. These are our advances in knowledge regarding the role of the parasympathetic nervous system in respiratory disease and the development of anticholinergic agents that have increased effectiveness with decreased side effects. This has been accomplished by alterations in the structure of the naturally occurring belladonna alkaloid, atropine. The major structural change, favorably altering the efficacy and side effect profile of atropine, is the introduction of a quaternary ammonium congener, ipratropium bromide (Fig. 1). The quaternary ammonium structure of ipratropium bromide differs from that of atropine in that the nitrogen atom is pentavalent and has a positive charge.
KeywordsChronic Obstructive Pulmonary Disease Allergic Rhinitis Nasal Spray Obstructive Lung Disease Common Cold
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