The development of anticholinergics in the management of COPD

Figures & data

Table 1 The beta2-agonists and anticholinergics

Medication	Mode of action	Reported side effects
Salbutamol	Rapid onset of action	Fine tremor
	Duration of action 3–5 hours	Headache
Terbutaline	Rapid onset of action	Nervous tension
	Duration of action 3–5 hours	Muscle cramps
Salmeterol	Maximum effect after 40 minutes	Tachycardia
	Duration of action 12 hours	Arrythmias
Formoterol	Rapid onset of action	Paradoxical bronchospasm
	Duration of action 12 hours+	Hypokalemia
		Urticaria
		Angioedema
		Sleep and behaviour disturbance in children
		Fall in oxygen saturations
Ipratropium	Maximum effect after 15–90 minutes	Dry mouth
		Nausea
	Duration of action 3–6 hours	Headache
Oxitropium	Maximum effect after 30–60 minutes	Urinary retention
		Blurred vision
	Duration of action 6 hours*	Glaucoma risk
	(*little evidence of longer duration than 6 hours)	Paradoxical bronchospasm
Tiotropium	Onset of action	Tachycardia and atrial fibrillation has been reported
	Duration of action 35 hours

Figure 1 The Spiriva^® HandiHaler^® (Boehringer Ingelheim Pharmaceuticals, Inc, Ridgefield, CT, USA).