Massey K L, Gotz V P
Drug Intell Clin Pharm. 1985 Jan;19(1):5-12. doi: 10.1177/106002808501900102.
Research clarifying the role of the parasympathetic nervous system in the pathophysiology of chronic obstructive pulmonary disease (COPD) has renewed interest in anticholinergic therapy of these disease processes. The investigational agent ipratropium bromide produces bronchodilation by competitive inhibition of cholinergic receptors on bronchial smooth muscle, antagonizing the action of acetylcholine. When administered via inhalation at therapeutic doses of 20-40 micrograms, ipratropium is somewhat less effective than beta-agonists in asthmatics. In the treatment of chronic bronchitis, however, ipratropium appears at least as effective as, and possibly superior to, the sympathomimetics. Combination therapy with beta-agonists or theophylline has resulted in enhanced effect over single-agent regimens. Due to the low serum concentrations achieved following inhalation, ipratropium has been well tolerated and is virtually free of significant adverse reactions. The primary role of ipratropium in therapy remains to be defined but appears to be as an alternative to beta-agonists in patients who fail to respond or who experience troublesome side effects. In addition, combination therapy may prove to be another important use of ipratropium in the management of COPD.
关于副交感神经系统在慢性阻塞性肺疾病（COPD）病理生理学中作用的研究，重新引发了人们对这些疾病进程抗胆碱能治疗的兴趣。研究药物异丙托溴铵通过竞争性抑制支气管平滑肌上的胆碱能受体产生支气管扩张作用，拮抗乙酰胆碱的作用。当以20 - 40微克的治疗剂量经吸入给药时，异丙托溴铵在哮喘患者中的效果略逊于β受体激动剂。然而，在慢性支气管炎的治疗中，异丙托溴铵似乎至少与拟交感神经药一样有效，甚至可能更优。与β受体激动剂或茶碱联合治疗比单一药物治疗方案效果更佳。由于吸入后血清浓度较低，异丙托溴铵耐受性良好，几乎没有明显不良反应。异丙托溴铵在治疗中的主要作用仍有待确定，但似乎可作为对β受体激动剂无反应或出现令人困扰副作用患者的替代药物。此外，联合治疗可能被证明是异丙托溴铵在COPD管理中的另一重要用途。
