How do inhaled
antimuscarinics work in asthma/COPD?
- Bronchodilation
- Bind to muscarinic receptors in smooth muscle, blocks the action of ACh
2 types of inhaled antimuscarinics
SAMA
LAMA
SAMA
short-acting muscarinic antagonist
* ipratropium
* Slower onset that SABA
Ipratropium inhaler examples
- MDI: Atrovent, Inhalvent
Ipratropium bromide - indication
- Ipratropium bromide by nebulisation can be added to other standard treatments in life-threatening asthma or if acute asthma fails to improve with standard therapy
- Ipratropium can be used as a nasal spray for rhinitis
Duration of action of ipratropium bromide
- Effect occurs within 30-60 minutes of inhalation (this is slower than SABA)
- Last up to 6 hours
- Can be given TDS (Max QDS)
What is the risk of nebulised ipratropium?
- Risk of acute-angle-closure-glaucoma (higher risk if given with nebulised salbutamol)
- STOP and seek medical attention - eye pain and changes in vision
LAMA inhaler examples
- Aclidinium bromide
- Glycopyrronium bromide
- Tiotropium
- Umeclidinium
Aclidinium bromide inhaler examples
- DPI: Ekilra
- With formoterol: Duaklir
Glycopyrronium bromide inhaler examples
- DPI: Seebri Breezhaler
- With Indacaterol (LABA):
Ultibro breezhaler
Tiotropium inhaler examples
- DPI: Braltus, Spiriva
- MDI: Spiriva Respimat
- With Olodaterol: Spiolto
respimat
What is the CSM
warning about Braltus (Tiotropium)?
- MHRA have had reports of people choking on the capsules
- Patients should be advised to store capsules in the screw-top bottle provided and never in the inhaler
- Check inhaler is clear of capsules before inhaling
Umeclidinium inhaler examples
- DPI: Incruse elipta
How often are LAMAs inhaled?
- All ONCE daily (EXCEPT Aclidinium which is TWICE DAILY)
- LAMAs have a longer duration of action and therefore are inhaled less frequently during the day
Which LAMA is the only one licensed for use in asthma?
Tiotropium (Spiriva Respimat)
Common SE
AM SE - acts on parasympathetic pathways
- Constipation
- Dry mouth
- Increased ocular pressure (report halos or blurred vision)
- Urinary retention
What drugs do inhaled antimuscarinics
interact with?
Other drugs which have antimuscarinic effects:
- tolterodine, oxybutinin, tamsulosin, solifenacin
- hyoscine
- TCAs
