Recommendation (American College of Chest Physicians/Canadian Thoracic Society Guidelines on the Prevention of COPD Exacerbations, 2015) (Chest, 2015) [MEDLINE]
In Moderate-Severe COPD, Long-Acting Muscarinic Antagonists (as Compared to Placebo) are Recommended to Prevent Moderate-Severe Acute COPD Exacerbations (Grade 1A Recommendation)
In Moderate-Severe COPD, Long-Acting Muscarinic Antagonists (as Compared to Long-Acting β2-Agonists) are Recommended to Prevent Moderate-Severe Acute COPD Exacerbations (Grade 1C Recommendation)
In Moderate-Severe COPD, Short-Acting Muscarinic Antagonist Monotherapy (as Compared to Short-Acting β2-Agonist Monotherapy) is Recommended to Prevent Mild-Moderate Acute COPD Exacerbations (Grade 2C Recommendation)
In Moderate-Severe COPD, Short-Acting Muscarinic Antagonist + Short-Acting β2-Agonist Combination Therapy (as Compared to Short-Acting β2-Agonist Monotherapy) is Recommended to Prevent Moderate Acute COPD Exacerbations (Grade 2B Recommendation)
In Moderate-Severe COPD, Long-Acting β2-Agonist Monotherapy (as Compared to Short-Acting Muscarinic Antagonist Monotherapy) is Recommended to Prevent Acute COPD Exacerbations (Grade 2C Recommendation)
In Moderate-Severe COPD, Long-Acting Muscarinic Antagonist Monotherapy (as Compared to Short-Acting Muscarinic Antagonist Monotherapy) is Recommended to Prevent Moderate-Severe Acute COPD Exacerbations (Grade 1A Recommendation)
In Moderate-Severe COPD, Short-Acting Muscarinic Antagonist + Long-Acting β2-Agonist Combination Therapy (as Compared to Long-Acting β2-Agonist Monotherapy) is Recommended to Prevent Mild-Moderate Acute COPD Exacerbations (Grade 2C Recommendation)
In Stable COPD, Long-Acting Muscarinic Antagonist + Long-Acting β2-Agonist Combination Therapy or Long-Acting Muscarinic Antagonist Monotherapy are Both Recommended to Prevent Acute COPD Exacerbations (Grade 1C Recommendation): both are equally effective
In Stable COPD, Inhaled Corticosteroid + Long-Acting β2-Agonist Combination Therapy or Long-Acting Muscarinic Antagonist Monotherapy are Both Recommended to Prevent Acute COPD Exacerbations (Grade 1C Recommendation): both are equally effective
In Stable COPD, Inhaled Corticosteroid + Long-Acting Muscarinic Antagonist + Long-Acting β2-Agonist Triple Therapy or Long-Acting Muscarinic Antagonist Monotherapy are Both Recommended to Prevent Acute COPD Exacerbations (Grade 2C Recommendation): both are equally effective
Prevention of acute exacerbations of COPD: American College of Chest Physicians and Canadian Thoracic Society Guideline. Chest. 2015 Apr;147(4):894-942. doi: 10.1378/chest.14-1676 [MEDLINE]
Adverse Effects
“Don’t Believe Your Eyes” Ipratropium Induced Mydriasis: A Case Report and Review of the Literature. Gen Med (Los Angel). 2016 Jun;4(3):255. doi: 10.4172/2327-5146.1000255 [MEDLINE]
Transient anisocoria in a patient treated with nebulized ipratropium bromide. Am J Ophthalmol Case Rep. 2017 Apr 12;7:11-13 [MEDLINE]