I farmaci antimuscarinici non selettivi : considerazioni sul loro impiego nella broncopneumopatia cronica ostruttiva (BPCO)

A number of data from animal models and humans supports the theory that alteration of parasympathetic neuronal control of respiratory smooth muscle may increase bronchoconstriction in response to vagal stimulation, leading to airway hyperresponsiveness. Even if the mechanism/s of this phenomenon, particularly evident in chronic obstructive pulmonary disease (COPD), is unknown, impairment of pulmonary parasympathetic control may play an important role. Nowadays the treatment of this condition with anticholinergic drugs has reached a great success. On this ground, the future for inhaled anticholinergic drugs for the treatment of COPD appears to remain in their combination with β2-agonists and phosphodiesterase-4 inhibitors. Non selective antimuscarinic compounds could be a good choice, since M2 muscarinic receptors on airway smooth muscle inhibit the formation of cyclic adenosine monophosphate. Moreover, a sufficient blockade of M3 muscarinic receptors would antagonize the increase of acetylcholine release due to the inhibition of neuronal M2 muscarini