The role of anticholinergics in asthma and COPD

Abstract

For centuries, physicians from various cultures and medical traditions have relied upon inhaled antimuscarinic agents to provide bronchodilator relief to their patients with obstructive respiratory diseases. No recorded history describes how the useful medicinal properties of alkaloid-containing plants were discovered, but careful records of antimuscarinic respiratory therapy are available from several cultures. In the ancient Ayurvedic literature of India and the pharmacopoeias of Europe and the United Kingdom in the 19th century, the preparation and administration of anticholinergic botanical derivatives are described. Many of the early observations of the clinical value of antimuscarinic bronchodilators have been validated in the modern era by pharmacological, physiological, clinical and biological studies. The pharmaceutical progeny of antimuscarinic botanicals are now the cornerstone of bronchodilator therapy in patients with chronic obstructive pulmonary disease and a useful supplemental bronchodilator for patients with asthma. In the following chapter, this rich medical history is reviewed briefly and the clinical role of modern pharmaceutical antimuscarinic bronchodilators is explored.