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Related Concept Videos

Direct-Acting Cholinergic Agonists: Therapeutic Uses01:11

Direct-Acting Cholinergic Agonists: Therapeutic Uses

Direct-acting cholinergic agonists have many therapeutic uses in various medical fields. Choline esters, including acetylcholine, have limited clinical utility due to their non-selectivity and short duration of action. Still, acetylcholine and carbachol are applied topically during ophthalmologic surgery to induce miosis. Pilocarpine, a muscarinic and ganglionic stimulator, effectively treats open-angle glaucoma and alleviates xerostomia and dry mouth caused by radiotherapy or Sjögren syndrome.
Indirect-Acting Cholinergic Agonists: Pharmacological Actions01:30

Indirect-Acting Cholinergic Agonists: Pharmacological Actions

Indirect-acting cholinergic agonists, also known as anticholinesterases, exert their pharmacological effects by enhancing cholinergic transmission in various body parts, including the neuromuscular junction, autonomic cholinergic synapses, and the brain.
At the neuromuscular junction, these agents work by inhibiting the breakdown of acetylcholine, allowing it to remain bound to the receptor and bind to nearby receptors. This process leads to repetitive firing of the endplate, causing muscle...
Cholinergic Antagonists: Pharmacokinetics01:24

Cholinergic Antagonists: Pharmacokinetics

Cholinergic antagonists—such as antimuscarinics—are available in oral, topical, ocular, parenteral, and inhalational formulations. Most antimuscarinics are oral formulations,  while scopolamine is available as a topical patch, and ipratropium and tiotropium are available as inhalation aerosols or powders. Atropine, tropicamide, and cyclopentolate are topically instilled in the eye. Most antimuscarinics are lipid-soluble and readily absorbed from the gastrointestinal tract and the conjunctiva.
Cholinergic Antagonists: Therapeutic Uses01:26

Cholinergic Antagonists: Therapeutic Uses

Antimuscarinic drugs have various therapeutic applications by inhibiting parasympathetic stimulation in different systems. Here are the key therapeutic uses of antimuscarinics:    
Respiratory Tract: Ipratropium, aclidinium, and tiotropium treat asthma, chronic bronchitis, and chronic obstructive pulmonary disease (COPD). They protect against bronchoconstriction caused by irritants like cigarette smoke, sulfur dioxide, and ozone. They also help reduce nasopharyngeal secretions in common...
Antiasthma Drugs: β2-Adrenoceptor Agonists01:25

Antiasthma Drugs: β2-Adrenoceptor Agonists

Bronchodilators are critical in managing asthma, a chronic respiratory condition characterized by airway constriction due to inflammation and hyper-reactivity. Specifically, bronchodilators ease this constriction by relaxing the bronchial muscles, facilitating easier breathing.
One class of bronchodilators includes β2-adrenoceptor agonists. These agents target the β2-adrenoceptors located on bronchial smooth muscle cells. By stimulating these receptors, β2-agonists induce relaxation in these...
Antiasthma Drugs: Muscarinic Receptor Antagonists01:20

Antiasthma Drugs: Muscarinic Receptor Antagonists

Muscarinic receptor antagonists, also known as antimuscarinic agents, are a class of bronchodilators used to treat asthma, although they are more commonly used to treat COPD. They work by inhibiting the action of acetylcholine (ACh), a neurotransmitter, on muscarinic receptors found in the airways.
Antimuscarinic agents compete with ACh for the same binding site on the muscarinic receptors. By binding to these receptors, they inhibit the downstream effects of ACh and block the parasympathetic...

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Updated: May 23, 2026

Bronchial Thermoplasty: A Novel Therapeutic Approach to Severe Asthma
14:39

Bronchial Thermoplasty: A Novel Therapeutic Approach to Severe Asthma

Published on: November 4, 2010

Anticholinergics in acute bronchial asthma.

S T Holgate1

  • 1Southampton General Hospital, Shirley, UK.

Postgraduate Medical Journal
|January 1, 1987
PubMed
Summary

Cholinergic antagonists like ipratropium bromide (IB) and oxitropium bromide (OB) help relax airways in asthma. Combining these bronchodilators with other asthma medications maximizes benefits without side effects.

Area of Science:

  • Pharmacology
  • Respiratory Medicine

Background:

  • Cholinergically-mediated reflex bronchoconstriction contributes to asthma-related airflow limitation.
  • Muscarinic cholinergic antagonists, including ipratropium bromide (IB) and oxitropium bromide (OB), act as bronchodilators and anti-bronchoconstrictors when administered locally to the airways.

Purpose of the Study:

  • To evaluate the role and efficacy of muscarinic cholinergic antagonists in asthma management.
  • To assess the benefits of combining IB and OB with other anti-asthma drugs.
  • To address safety concerns regarding preservatives in nebulizer solutions.

Main Methods:

  • Review of animal and human studies on cholinergic mechanisms in asthma.
  • Pharmacokinetic and therapeutic ratio analysis of IB and OB compared to older anticholinergics.

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Last Updated: May 23, 2026

Bronchial Thermoplasty: A Novel Therapeutic Approach to Severe Asthma
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10:20

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  • Evaluation of combination therapy with IB/OB and other asthma medications.
  • Assessment of the impact of preservative removal (EDTA, benzylchonium chloride) on nebulizer solutions.

    • Main Results:

    • Inhaled IB and OB demonstrate bronchodilator and anti-bronchoconstrictor effects.
    • While not first-line treatments for acute asthma, IB and OB provide therapeutic benefits when used in combination therapy.
    • Combination therapy enhances bronchodilation without significant systemic side effects.
    • Removal of EDTA and benzylchonium chloride from Atrovent nebulizer solution eliminated the risk of paradoxical bronchoconstriction.

    Conclusions:

    • Muscarinic cholinergic antagonists are valuable adjuncts in asthma therapy, particularly in combination regimens.
    • Optimizing bronchodilator effects through combination therapy offers a favorable risk-benefit profile.
    • Formulation improvements in nebulizer solutions have enhanced patient safety by removing potential irritants.