What Kind of Medications Are There For COPD?

HomeCOPD GuidelinesFor PatientsWhat Kind of Medications Are There For COPD? ▶ What Are Anticholinergic Medications?

What Are Anticholinergic Medications?

Anticholinergic drugs are another group of bronchodilators that are different from the beta-agonists. While the beta-agonists affect the bronchioles (small airways), anticholinergics affect the muscles around the bronchi (large airways). When the lungs are irritated, these bands of muscle can tighten, making the bronchi narrower. Anticholinergics work by stopping the muscles from tightening.

What kinds of anticholinergics are there?
There are two kinds of anticholinergics used to treat COPD. These are grouped according to how long they work and are called short-acting and long-acting anticholinergics. These medications can be delivered by either an inhaler or a nebulizer.

What are short- and long-acting anticholinergics?
Short-acting anticholinergic medications work in about 15 minutes and last for 6-8 hours. Some providers do not consider these drugs as reliever medication because they take longer to work than beta-agonist drugs. Conversely, because they are good bronchodilators with less side-effects than beta-agonist drugs, some believe these drugs should be the main drug given in the treatment of COPD.

List of short-acting anticholinergics

Generic name Brand name How it is given Dosage
ipratropium bromide Atrovent MDI
Liquid for nebulizer
2-4 puffs 3-4 times daily
40-80 µg 4 times daily
500 ?g vial 4 times daily
oxitropium bromide Oxivent MDI
2 puffs 2-3 times daily
200 µg twice daily
µg stands for micrograms.

There is, to date, only one long-acting anticholinergic drug available, called tiotropium. Tiotropium takes about 20 minutes to work and lasts for 24 hours, therefore, it is taken only once a day for maintenance.

List of long-acting anticholinergics

Generic name Brand name How it is given Dosage
tiotropium Spiriva DPI Inhale contents of 1 capsule daily

What problems (side-effects) should I watch for with anticholinergic drugs?
Anticholinergic medication does not seem to have as many noticeable side-effects as beta-agonists. The side-effects that are experienced include dry mouth, blurred vision (if spray comes in contact with the eyes), worsening glaucoma and dry cough. Men with prostate problems may find more difficulty urinating.

How often and how much anticholinergic medication should I take?
Since the short-acting anticholinergics take 20-30 minutes to have a good effect, they are not considered the ideal "reliever" medication. However, since they last 6-8 hours, they can be taken 3-4 times a day for good maintenance coverage. The new long-acting anticholinergics are not yet available in all countries. Like the short-acting drugs, they take 20-30 minutes to have a good effect. They also are not considered the ideal "reliever" medication, however, because they last for 24 hours, they provide excellent coverage as a maintenance medication.

What should I do if I forget to take my anticholinergic medication?
Anticholinergic medications have minimal serious side-effects, therefore, if a person cannot remember if they’ve taken their dosage, they can usually take another dose of the drug without problems. However, as with any questions about taking medications, consult with your healthcare provider before making changes to how you take your medications.

Last Reviewed: February 2015