Potential for long-acting muscarinic antagonists in chronic obstructive pulmonary disease.

IMPORTANCE OF THE FIELD: The prevention and relief of symptoms by regular use of bronchodilators is central to the pharmacological management of chronic obstructive pulmonary disease (COPD). AREAS COVERED IN THIS REVIEW: The aim of this article is to review the effects of inhaled muscarinic antagonists in the treatment of stable COPD. WHAT THE READER WILL GAIN: An update of the clinical studies performed with the long-acting inhaled muscarinic antagonist (LAMA) tiotropium bromide in patients with COPD is given. In recent years, combinations of a LAMA and a long-acting inhaled beta2-agonist (LABA), and 'triple therapy' consisting of a LAMA, a LABA, and an inhaled steroid are being developed. Issues of safety of inhaled anticholinergics in COPD are discussed and a short overview of new LAMAs being developed for COPD is given. TAKE HOME MESSAGES: The importance of anticholinergic drug treatment in COPD was largely advanced by the development of the first LAMA, tiotropium bromide. The vast experience obtained with tiotropium bromide has paved the way for new LAMAs such as aclidinium bromide and glycopyrrolate (NVA-237).