Medications

Anticholinergic Agents

Anticholinergic agents relax the bronchial muscles. They are generally inhaled and act as a bronchodilator over time.

Brands and Benefits. Anticholinergics used for COLD include ipratropium (Atrovent) and tiotropium (Spiriva). Ipratropium is the older agent and experts recommend it as the first choice in treating COLD. It has a very slow onset and can be used as maintenance therapy for people with emphysema and chronic bronchitis. Anticholinergic agents have few severe side effects.They are less likely to impair sleep than the other standard inhaled medications.

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A patient should not take more than 12 inhalations per day. Tiotropium (Spiriva) requires only one daily inhalation and evidence suggests it may be particularly effective for COLD patients. A single inhaler containing both ipratropium and the common beta2 agonist albuterol (Combivent) may prove to be better than either agent alone. Anticholinergics target the central airways and beta agonists target peripheral airways, thus explaining, so some doctors hypothesize, the additive benefits of the combination.

Side Effects. Some common side effects include blurred vision and urinary obstruction. Patients with allergies to soy or peanut products should not use these drugs. Those with glaucoma should be very careful to prevent being sprayed in the eye with the drug, which could worsen the condition.

Beta2 Agonists

Beta2 agonists are the most widely prescribed bronchodilators, most often for asthma. These drugs are generally inhaled using a metered-dose inhaler (MDI) or nebulizer. A nebulizer delivers a larger dose of the drug and is more expensive than the MDI. Experts recommend the inhaler for most patients and suggest reserving the nebulizer for patients with severe disease who are unable to use the MDI. Survival rates are similar. Beta2 agonists are also available in oral forms, although have more side effects than inhaled beta2 agonists and have a slower onset of action. Oral beta2 agonists should be reserved only for patients who cannot use other forms.