Anticholinergic Bronchodilators

Anticholinergic Bronchodilators: Known as "Back Door Bronchodilators", part of the Controller Family of inhaled respiratory medications.

Ipratropium Bromide: Commonly combined with Albuterol for enhanced bronchodilation (DuoNeb).

Clinical Indications:

• COPD maintenance treatment.

• Can be used in some asthma patients.

• Used in combination with β-agonist bronchodilators for COPD with airflow obstruction.

• Anticholinergic nasal sprays for allergic and nonallergic rhinitis.

Inhaled Anticholinergic Agents:

• Ipratropium Bromide (Atrovent), Ipratropium and Albuterol (Combivent), Aclidinium Bromide (Tudorza), Glycopyrrolate, Tiotropium (Spiriva), and Umeclidinium.

Ipratropium Bromide Details:

• Available as MDI, SVN solution, and nasal spray.

• Used for COPD; limited distribution when inhaled.

Combination Therapies:

• Ipratropium and Albuterol more effective together.

Once-Daily Anticholinergics: Include Tiotropium, Umeclidinium, and their combinations.

Mechanism & Effects:

• Relieve bronchoconstriction through muscarinic receptor antagonism (M1, M2, M3).

Adverse Effects:

• Common: Dry mouth, cough, mydriasis.

• Rare changes in BP/HR.

Clinical Applications:

• More potent bronchodilators in COPD than β-agonists.

• May be considered for nocturnal or psychogenic asthma.

Combination Therapy Effectiveness:

• Complementary actions, studies show significant increases in lung function when using both

Respiratory Care Assessment: Monitor effectiveness, respiratory rates, oxygen saturation, and correct use of devices for long-term care.