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Lee, Cho, and Han: Issues on Safety of Long-Acting Muscarinic Antagonist
Review
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2011; 70(5): 384-389.

Published online: 31 May 2011

DOI: https://doi.org/10.4046/trd.2011.70.5.384

Issues on Safety of Long-Acting Muscarinic Antagonist

Yang Deok Lee, M.D., Ph.D.1, 2, Yongseon Cho, M.D., Ph.D.1, Min Soo Han, M.D., Ph.D.1

1Department of Internal Medicine, Eulji University School of Medicine, Daejeon, Korea.

2Eulji Medi-Bio Research Institute, Eulji University School of Medicine, Daejeon, Korea.

Address for correspondence: Yang Deok Lee, M.D., Ph.D. Department of Internal Medicine, Eulji University Hospital, 1306, Dunsan-dong, Seo-gu, Daejeon 302-799, Korea. Phone: 82-42-611-3154, Fax: 82-42-259-1111, lydmd@hanmail.net

Received 8 March 2011       Accepted 10 April 2011

Copyright © 2011. The Korean Academy of Tuberculosis and Respiratory Diseases. All rights reserved.

Abstract

The prevention of and the controlling of symptoms, reductions in the frequency of exacerbations, and disease severity are central to the pharmacologic therapy of chronic obstructive pulmonary disease (COPD). COPD patients are inclined to be older, have more comorbidities, and use polypharmacy as a result. Long-acting inhaled muscarinic antagonists (LAMAs) is a preferred treatment modality. However, the cardiovascular (CV) safety of anti-cholinergics, including LAMA, has been an issue. In contrast, the results of the UPLIFT trial and a pooled analysis of data from 30 trials of tiotropium illustrates the association of tiotropium with reductions in the risk of all cause mortality, CV mortality and CV events. And, the UPLIFT trial provides clues regarding the additive advantages of tiotropium in COPD patients who already are using long-acting inhaled β2 agonists and inhaled corticosteroids. Following the contribution of tiotropium as a first LAMA, new LAMAs such as aclidinium and glycopyrrolate (NVA-237) seem to be emerging.

Keywords: Pulmonary disease, Chronic Obstructive, Cholinergic Antagonists, tiotropium, Muscarinic Antagonists

Figures and Tables

Table 1
Comparison of tiotropium with new LAMAs
trd-70-384-i001

*Bronchoprotection against acethylcholine in the vivo setting 24 hours after administration when applied at equieffective doses.

LAMA: long actinting muscarinic antagonist; DPI: dry powder inhaler; t1/2 for hM3: dissociation half-lives for LAMA from hM3 receptor.

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