AN INTERNATIONAL PERSPECTIVE ON ANTICHOLINERGIC THERAPY

Since the introduction of inhaled quaternary anticholinergic bronchodi lators, their clinical usefulness has been explored in a variety of se ttings. They have emerged as the inhaled bronchodilators of first choi ce in the management of chronic obstructive pulmonary disease (COPD). In other countries, they have also found an adjunctive role in the man agement of asthma. This may be best seen in the treatment of acute ast hma where the combination of anticholinergic and adrenergic bronchodil ators appear more effective than single-agent inhalation therapy. This finding appears consistently in large studies, whether in adult or pe diatric populations. Such combination nebulizer therapy would appear t o be cost effective, but further study is required.