Anticholinergic agents have been available for the treatment of airways obstruction for many decades. For patients with chronic obstructive pulmonary disease (COPD), many practitioners believe that these drugs have become the bronchodilator of choice. For patients with asthma, anticholinergic agents are less popular, probably because of their slower onset of action as a reliever medication and their generally inferior effect on lung function and symptoms, as compared with inhaled beta-agonists.

Not surprisingly, long-acting beta-agonists (LABAs) in combination with inhaled glucocorticoids have become standard treatment for patients with asthma that is poorly controlled while receiving inhaled glucocorticoids alone. Although this treatment is effective in a majority of patients, many patients have poor asthma control despite taking LABAs combined with high doses of inhaled glucocorticoids. For these patients, there are few therapeutic options. Most of them have already been treated with leukotriene modifiers; the addition of oral glucocorticoids may be effective but is associated with severe side effects, and the addition of anti-IgE treatment is expensive and elicits a response in only a small subpopulation. Long-acting anticholinergic agents are not mentioned in treatment guidelines, despite their availability since 2004. ...

Author : Elisabeth H. Bel, M.D., Ph.D.
Source : N Engl J Med 2012; 367:1257-1259 September 27, 2012