Introduction

This information is for people who have chronic obstructive pulmonary disease (COPD). It tells you about inhalers containing anticholinergic drugs, a treatment for COPD. It is based on the best and most up-to-date research.

Do they work?

Yes. Using an inhaler containing an anticholinergic drug can help you if you have chronic obstructive pulmonary disease (COPD). There's a good chance that with this medicine you'll be able to breathe more easily. You may find that these drugs help you feel less breathless and that you wheeze less.

There are two main types of inhaler that help breathlessness in COPD. The type we talk about here contain anticholinergic drugs. The other contains beta-2 agonists. Both types relax and open up your airways, but they work in different ways. The research doesn't say which one is best. You may have to try both to find out which works best for you.

What are they?

Anticholinergic drugs open up your airways by relaxing the muscles in your lungs. You may hear them called bronchodilators, because they open up (dilate) the airways (bronchial tubes).

Your doctor needs to prescribe them for you. You can't buy them over the counter. There are two types.

• Short-acting anticholinergics work quickly and the effect lasts for three hours to four hours. The one that's usually used is called ipratropium (Atrovent).

• Long-acting anticholinergics last longer, so you only need to take them once a day. The only type available in the UK is called tiotropium (Spiriva). It's available as capsules, which you put into an inhaler called a HandiHaler. It also comes in an inhaler that delivers the drug as a mist (Respimat Soft Mist inhaler).

You usually use short-acting inhalers whenever you're having trouble breathing. Alternatively, your doctor might advise you to use your inhaler at regular intervals, three or four times a day, to keep your airways open.

Long-acting inhalers don't work very quickly, so they aren't used for fast relief when you have a sudden breathing problem. Instead, you take them regularly, once a day, to keep your airways open.

The National Institute for Health and Clinical Excellence (NICE) is the organisation that decides which treatments should be available on the NHS. NICE recommends that doctors prescribe a short-acting drug, such as ipratropium, to make you less breathless and able to be more active. If you still have problems, a long-acting drug, such as tiotropium, may be better for you. ^[16]

You take anticholinergic drugs using an inhaler. The metered-dose inhaler (MDI) is the most common kind. It's a small plastic holder with a slot where you put an aerosol canister. Pressing on the canister releases exactly one dose of the medicine. It comes out as a puff of tiny droplets that you slowly breathe in through your mouth.