Respiratory/Antimuscarinic bronchodilator (LAMA/SAMA)

Antimuscarinic bronchodilators

also: ipratropium · tiotropium · LAMA · SAMA

Overview

Anticholinergic bronchodilators — central to COPD (LAMA) and used in acute severe asthma/COPD (ipratropium).

Mechanism

Block muscarinic M3 receptors on bronchial smooth muscle → reduce vagal bronchoconstriction → bronchodilation + ↓mucus. SAMA (ipratropium) short-acting; LAMA (tiotropium) long-acting.

Indications

COPD (LAMA = cornerstone maintenance)
Acute severe asthma / COPD exacerbation (nebulised ipratropium)
Asthma add-on (tiotropium, specialist)

The agents

IpratropiumSAMA

short-acting

Acute exacerbations (nebulised, with salbutamol).

Tiotropium / glycopyrronium / umeclidiniumLAMA

OD/BD

COPD maintenance (often LABA+LAMA combination).

Adverse effects

Dry mouthclassic

Urinary retention, constipation (antimuscarinic)common

Blurred vision / acute angle-closure glaucoma (nebulised near eyes)serious

Cautions & contraindications

Caution: bladder outflow obstruction, angle-closure glaucomaall

Antimuscarinic effects.

Interactions

Additive antimuscarinic burden

Monitoring & kinetics

Inhaler technique; COPD symptoms/exacerbations

Inhaled. COPD step-up: SABA/SAMA → LABA+LAMA → add ICS if asthmatic features/eosinophilia.

Source: NICE NG115 — COPD · BNF — Antimuscarinic bronchodilators