Pharmacological Management: Anticholinergic Agents

Kelsey Hawkins, PharmD, and Bindu George, MD

Introduction

•There are many medications with anticholinergic properties that are approved for a wide variety of indications. Anticholinergic medications can be classified as (a) antimuscarinic agents that act on muscarinic acetylcholine receptors and (b) antinicotinic agents that act on nicotinic acetylcholine receptors. Inhaled anticholinergic agents are prescribed for children with respiratory disease to decrease airway secretions and/or act as cough suppressants.

•This chapter is limited to a discussion of inhaled anticholinergic (antimuscarinic) agents and their role in respiratory disease in children.

•Currently, inhaled anticholinergic agents are approved by the U.S. Food and Drug Administration (FDA) for the treatment of chronic obstructive pulmonary disease (COPD) in adults, and tiotropium is FDA approved for the treatment of asthma in children ≥6 years old.

•Although not all agents are FDA approved, anticholinergic agents have been used off-label in children with asthma and bronchopulmonary dysplasia (BPD).

•Inhaled anticholinergic agents include

—Ipratropium bromide (short acting)

—Tiotropium (long acting)

•Several newer inhaled long-acting muscarinic antagonists (LAMAs) have been approved for the treatment of COPD in adults and are being studied in both adults and children for the treatment of asthma. These agents include

—Aclidinium bromide

—Umeclidinium bromide

—Glycopyrrolate

Mechanism of Action/Pharmacology

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