Soler Xavier, Ramsdell Joe
Department of Medicine, University of California, 200 West Arbor Dr., San Diego, CA, 92103, USA.
Curr Allergy Asthma Rep. 2014 Dec;14(12):484. doi: 10.1007/s11882-014-0484-y.
Anticholinergic alkaloids have been used for thousands of years for the relief of bronchoconstriction and other respiratory symptoms, and their use in the treatment of chronic obstructive pulmonary disease is well established. Acetylcholine, acting through muscarinic receptor (M) receptor, modulates multiple physiologic functions pertinent to asthma including airway muscle tone, mucus gland secretion, and various parameters of inflammation and remodeling. In addition, activation of M receptors may inhibit beta2 adrenoreceptor. These observations offer the rationale for the use of M receptors antagonists in the treatment of asthma. Short-acting antimuscarinic agents may be effective alone or in combination with short-acting beta agonists for the relief of acute symptoms. Long-acting antimuscarinic agents have emerged as potentially useful in the long-term treatment of difficult-to-control asthma. This review will analyze the mechanisms of action and therapeutic role of antimuscarinic agents on asthma including current guidelines regarding antimuscarinic drugs, recent studies in asthma, special populations to consider, and possible predictors of response.
抗胆碱能生物碱用于缓解支气管收缩和其他呼吸道症状已有数千年历史，其在慢性阻塞性肺疾病治疗中的应用已得到充分确立。乙酰胆碱通过毒蕈碱受体（M受体）发挥作用，调节与哮喘相关的多种生理功能，包括气道肌肉张力、黏液腺分泌以及炎症和重塑的各种参数。此外，M受体的激活可能抑制β2肾上腺素能受体。这些观察结果为使用M受体拮抗剂治疗哮喘提供了理论依据。短效抗毒蕈碱药物单独使用或与短效β激动剂联合使用可能有效缓解急性症状。长效抗毒蕈碱药物已成为难控制哮喘长期治疗中潜在有用的药物。本综述将分析抗毒蕈碱药物对哮喘的作用机制和治疗作用，包括关于抗毒蕈碱药物的现行指南、哮喘的最新研究、需考虑的特殊人群以及可能的反应预测指标。
