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The Laryngoscope Apr 2023Topical intranasal anticholinergics are commonly prescribed for the relief of chronic rhinitis and associated symptoms, warranting thorough assessment of the supporting... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Topical intranasal anticholinergics are commonly prescribed for the relief of chronic rhinitis and associated symptoms, warranting thorough assessment of the supporting evidence. The present study aimed to evaluate the safety and efficacy of anticholinergic nasal sprays in the management of allergic and non-allergic rhinitis symptom severity and duration.
METHODS
A search encompassing the Cochrane Library, PubMed/MEDLINE, and Scopus databases was conducted. Primary studies describing rhinorrhea, nasal congestion, and/or postnasal drip outcomes in rhinitis patients treated with an anticholinergic spray were included for review.
RESULTS
The search yielded 1,029 unique abstracts, of which 12 studies (n = 2,024) met inclusion criteria for qualitative synthesis and 9 (n = 1,920) for meta-analysis. Median follow-up was 4 weeks and ipratropium bromide was the most extensively trialed anticholinergic. Compared to placebo, anticholinergic treatment was demonstrated to significantly reduce rhinorrhea severity scores (standardized mean difference [95% CI] = -0.77 [-1.20, -0.35]; -0.43 [-0.72, -0.13]) and duration (-0.62 [-0.95, -0.30]; -0.29 [-0.47, -0.10]) in allergic and non-allergic rhinitis patients respectively. Benefit was less consistent for nasal congestion, postnasal drip, and sneezing symptoms. Reported adverse effects included nasal mucosa dryness or irritation, epistaxis, headaches, and pharyngitis, though comparison to placebo found significantly greater risk for epistaxis only (risk ratio [95% CI] = 2.19 [1.22, 3.93]).
CONCLUSION
Albeit treating other symptoms with less benefit, anticholinergic nasal sprays appear to be safe and efficacious in reducing rhinorrhea severity and duration in both rhinitis etiologies. This evidence supports their continued use in the treatment of rhinitis-associated rhinorrhea.
LEVEL OF EVIDENCE
1 Laryngoscope, 133:722-731, 2023.
Topics: Humans; Rhinitis; Cholinergic Antagonists; Nasal Sprays; Epistaxis; Rhinorrhea
PubMed: 35838014
DOI: 10.1002/lary.30306 -
Drug Design, Development and Therapy 2018Penehyclidine hydrochloride (PHC) is an anticholinergic drug manufactured in China. It is used widely in clinics as a reversal agent in cases of organic phosphorus... (Review)
Review
BACKGROUND
Penehyclidine hydrochloride (PHC) is an anticholinergic drug manufactured in China. It is used widely in clinics as a reversal agent in cases of organic phosphorus poisoning and as a preanesthetic medication. Compared with other anticholinergic agents, PHC confers substantial advantages. Here, in this review, we focus on its important clinical effects for organic phosphorus poisoning, preanesthetic medication, and the protective effects on certain visceral organs.
MATERIALS AND METHODS
Our bibliographic sources include the PubMed and China National Knowledge Infrastructure (CNKI) databases, updated in March 2018. To assess the data in detail, we used the search terms "penehyclidine hydrochloride," "preanesthetic medication," and "organic phosphorus." Papers were restricted to those published in the English and Chinese languages, and to "paper" and "review" as the document type.
RESULTS
PHC can effectively antagonize the symptoms of central and peripheral poisoning caused by organophosphorus poisoning. As a preanesthetic medication, it can not only effectively reduce mucus secretion and vascular infiltration but can also relax airway smooth muscles, dilate bronchioles in pulmonary conditions such as bronchiectasis, and increase pulmonary dynamic compliance. It can also prevent reflexive actions of the vagus nerve caused by excessive acetylcholine release such as abnormal airway contraction. Furthermore, it can strengthen sedation, bidirectionally regulate heart rate, and effectively inhibit respiratory secretions. In recent studies, PHC was shown to also have protective effects on various organs, such as the heart, lungs, brain, kidneys, intestines, and liver.
CONCLUSION
PHC has beneficial pharmacological properties used in the treatment of organophosphorus poisoning and as a preanesthetic medication for its few side effects. It also has protective effects on multiple organs, suggesting that PHC has extensive clinical application value which is worth further research. This review should be of help to those intending to research these topics further.
Topics: Animals; Cholinergic Antagonists; Humans; Organophosphate Poisoning; Preanesthetic Medication; Quinuclidines
PubMed: 30323561
DOI: 10.2147/DDDT.S177435 -
Drugs & Aging Oct 2019Understanding risk factors associated with falls is important for optimizing care and quality of life for older patients. (Observational Study)
Observational Study
BACKGROUND
Understanding risk factors associated with falls is important for optimizing care and quality of life for older patients.
OBJECTIVE
Our objective was to determine the relationship between anticholinergic exposure and falls, fractures, and all-cause mortality.
METHODS
An observational retrospective cohort study was conducted using administrative claims data from 1 January 2007 to 30 September 2015. Individuals aged 65-89 years newly diagnosed or treated for overactive bladder (OAB) were identified. Index date was the first OAB diagnosis or OAB medication prescription claim. Follow-up began on the index date and continued until death, disenrollment, or end of study period. The Anticholinergic Cognitive Burden (ACB) scale was used to define and quantify daily anticholinergic exposure and intensity. The primary study outcome was a combined endpoint of falls or fractures. All-cause mortality was a secondary endpoint.
RESULTS
There were 113,311 patients with mean age of 74.8 ± standard deviation (SD) 6.2 years included. Current anticholinergic exposure was associated with a 1.28-fold increased hazard of a fall/fracture (95% confidence interval [CI] 1.23-1.32) compared with unexposed person-time, and past exposure was associated with a 1.14-fold increased hazard of a fall/fracture (95% CI 1.12-1.17). Compared with unexposed person-time, low-, moderate-, and high-intensity anticholinergic exposure was associated with a 1.04-fold (95% CI 1.00-1.07), 1.13-fold (95% CI 1.09-1.17), and 1.31-fold (95% CI 1.26-1.36) increased hazard of falls/fractures, respectively. A similar pattern was observed for all-cause mortality.
CONCLUSIONS
Anticholinergic exposure is associated with an increased risk of falls or fractures in older patients and is an important consideration when evaluating treatment options for such patients with OAB.
Topics: Accidental Falls; Aged; Cholinergic Antagonists; Female; Fractures, Bone; Humans; Male; Medicare; Quality of Life; Retrospective Studies; Risk Factors; United States; Urinary Bladder, Overactive
PubMed: 31359329
DOI: 10.1007/s40266-019-00694-5 -
American Family Physician Sep 2019
Review
Topics: Administration, Cutaneous; Cholinergic Antagonists; Glycopyrrolate; Humans; Hyperhidrosis
PubMed: 31524358
DOI: No ID Found -
Journal of Alzheimer's Disease : JAD 2018Anticholinergic burden is associated with poorer cognitive and functional outcomes in people with dementia. However, the impact of anticholinergics on significant...
BACKGROUND
Anticholinergic burden is associated with poorer cognitive and functional outcomes in people with dementia. However, the impact of anticholinergics on significant adverse outcomes such as stroke has not been studied previously.
OBJECTIVE
To investigate the association between total anticholinergic cognitive burden (ACB) and risk of stroke and death in people with different dementia subtypes.
METHODS
This was a cohort study of 39,107 people with dementia and no prior history of stroke registered in the Swedish Dementia Registry (SveDem) from 2008-2014. Data were extracted from the Swedish Prescribed Drug Register, the Swedish National Patient Register, and the Swedish Total Population Register. Competing risk regression models were used to compute hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between time-varying ACB score and risk of stroke and all-cause mortality.
RESULTS
During a mean follow-up period of 2.31 (standard deviation 1.66) years, 11,224 (28.7%) individuals had a stroke or died. Compared with non-users of anticholinergic medications, ACB score of 1 (HR 1.09, 95% CI 1.04-1.14) and ACB score of ≥2 (HR 1.20, 95% CI 1.14-1.26) increased the risk of developing the composite outcome of stroke and death. When stratifying by dementia disorder, the association remained significant in Alzheimer's disease, mixed dementia, and vascular dementia.
CONCLUSIONS
The use of anticholinergic medicines may be associated with an increased risk of stroke and death in people with dementia. A dose-response relationship was observed. Careful consideration should be made when prescribing medications with anticholinergic properties to people with dementia.
Topics: Aged; Aged, 80 and over; Brain Ischemia; Cholinergic Antagonists; Cohort Studies; Dementia; Dose-Response Relationship, Drug; Female; Follow-Up Studies; Humans; Male; Stroke
PubMed: 30056424
DOI: 10.3233/JAD-180353 -
American Family Physician Jan 2017
Review
Topics: Administration, Inhalation; Bronchodilator Agents; Cholinergic Antagonists; Humans; Pulmonary Disease, Chronic Obstructive; Quinuclidines; Treatment Outcome
PubMed: 28084712
DOI: No ID Found -
Toxicology Letters Mar 2015Organophosphosphates (OPs) are highly effective acetylcholinesterase (AChE) inhibitors that are used worldwide as cheap, multi-purpose insecticides. OPs are also used as... (Review)
Review
Organophosphosphates (OPs) are highly effective acetylcholinesterase (AChE) inhibitors that are used worldwide as cheap, multi-purpose insecticides. OPs are also used as chemical weapons forming the active core of G-series and V-series chemical agents including tabun, sarin, soman, cyclosarin, VX, and their chemical analogs. Human exposure to any of these compounds leads to neurotoxic accumulation of the neurotransmitter acetylcholine, resulting in abnormal nerve function and multiple secondary health complications. Suicide from deliberate exposure to OPs is particularly prevalent in developing countries across the world and constitutes a major global health crisis. The prevalence and accessible nature of OP compounds within modern agricultural spheres and concern over their potential use in biochemical weapon attacks have incentivized both government agencies and medical researchers to enact stricter regulatory policies over their usage and to begin developing more proactive medical treatments in cases of OP poisoning. This review will discuss the research undertaken in recent years that has investigated new supplementary drug options for OP treatment and support therapy, including progress in the development of enzymatic prophylaxis.
Topics: Animals; Cholinergic Antagonists; Cholinesterase Reactivators; Humans; Organophosphate Poisoning
PubMed: 25595305
DOI: 10.1016/j.toxlet.2015.01.007 -
Journal of Clinical Pharmacy and... Apr 2019Anticholinergic drug use has been associated with a risk of central and peripheral adverse effects. There is a lack of information on anticholinergic drug use in persons...
WHAT IS KNOWN AND OBJECTIVE
Anticholinergic drug use has been associated with a risk of central and peripheral adverse effects. There is a lack of information on anticholinergic drug use in persons with diabetes. The aim of this study is to investigate anticholinergic drug use and the association between anticholinergic drug use and self-reported symptoms in older community-dwelling persons with and without diabetes.
METHODS
The basic population was comprised of Finnish community-dwelling primary care patients aged 65 and older. Persons with diabetes were identified according to the ICD-10 diagnostic codes from electronic patient records. Two controls adjusted by age and gender were selected for each person with diabetes. This cross-sectional study was based on electronic primary care patient records and a structured health questionnaire. The health questionnaire was returned by 430 (81.6%) persons with diabetes and 654 (73.5%) persons without diabetes. Data on prescribed drugs were obtained from the electronic patient records. Anticholinergic drug use was measured according to the Anticholinergic Risk Scale. The presence and strength of anticholinergic symptoms were asked in the health questionnaire.
RESULTS AND DISCUSSION
The prevalence of anticholinergic drug use was 8.9% in the total study cohort. There were no significant differences in anticholinergic drug use between persons with and without diabetes. There was no consistent association between anticholinergic drug use and self-reported symptoms.
WHAT IS NEW AND CONCLUSION
There is no difference in anticholinergic drug use in older community-dwelling persons with and without diabetes. Anticholinergic drug use should be considered individually and monitored carefully.
Topics: Aged; Aged, 80 and over; Cholinergic Antagonists; Cohort Studies; Cross-Sectional Studies; Diabetes Mellitus; Female; Finland; Humans; Independent Living; Male; Practice Patterns, Physicians'; Primary Health Care; Self Report; Surveys and Questionnaires
PubMed: 30315583
DOI: 10.1111/jcpt.12772 -
Archives of Psychiatric Nursing Jun 2023We aimed in this study to determine the extent of exposure to anticholinergic drugs in older adults with psychiatric illnesses using the anticholinergic cognitive burden...
OBJECTIVES
We aimed in this study to determine the extent of exposure to anticholinergic drugs in older adults with psychiatric illnesses using the anticholinergic cognitive burden (ACB) scale and to identify the factors associated with anticholinergic drugs use and higher ACB scores.
METHODS
A cross-sectional study was conducted in the psychogeriatric division of an elderly care hospital. The study sample comprised all inpatients, aged ≥65 years, and diagnosed with psychiatric illness.
RESULTS
Anticholinergic drugs use was reported in 117 (79.6 %) patients, 76 (51.7 %) had an ACB score ≥ 3. Schizophrenia [OR = 5.4 (95 % CI 1.1-10.2), p = 0.02], anemia [OR = 2.2 (95 % CI 1.54-7.89), p = 0.01], and anticholinergic adverse effects [OR = 2.8 (95 % CI 1.12-7.07), p = 0.04] were significantly associated with a higher likelihood of using anticholinergic drugs. The odds of having an ACB score ≥ 3 over an ACB score = 0 were significantly increased by schizophrenia [OR = 4.9 (95 % CI 1.65-8.02), p = 0.01], anemia [OR = 1.32 (95 % CI 1.90-6.90), p = 0.02], and polypharmacy [OR = 1.74 (95 % CI 1.10-2.40), p = 0.04], while they were significantly decreased by age [OR = 0.86 (95 % CI 0.78-0.96), p < 0.001]. Patients with cognitive impairment were less likely than those without cognitive impairment to have an ACB score ≥ 3 over an ACB score = 0.
CONCLUSIONS
Our study revealed that older adults with psychiatric illnesses were exposed to high anticholinergic burden.
Topics: Humans; Aged; Cholinergic Antagonists; Cross-Sectional Studies; Hospitals; Inpatients; Mental Disorders
PubMed: 37197858
DOI: 10.1016/j.apnu.2023.03.006 -
The American Journal of Medicine Jun 2018The incidence of chronic obstructive pulmonary disease (COPD) is rising in the United States, and the disease represents a significant source of morbidity and mortality.... (Review)
Review
The incidence of chronic obstructive pulmonary disease (COPD) is rising in the United States, and the disease represents a significant source of morbidity and mortality. Primary care providers face many challenges in COPD diagnosis and treatment, as different clinical phenotypes require personalized treatment approaches. Patient adherence and inhaler technique also contribute to treatment outcomes. Around 48% of primary care providers are unaware of guidelines and recommendations for COPD diagnosis and treatment, which may lead to misdiagnosis or undertreatment of COPD symptoms. Inadequately treated COPD can impair patients' quality of life and ability to perform everyday activities. Long-acting bronchodilator therapy is the cornerstone treatment for patients with COPD; combinations of bronchodilators of different pharmacological classes have shown improved efficacy vs monotherapy. We review the rationale behind fixed-dose dual bronchodilator therapy, evidence for the 4 currently Food and Drug Administration-approved long-acting anticholinergic bronchodilators/long-acting β-agonists fixed combinations, patient suitability for the available inhaler devices, and practical guidance to optimize personalized care for patients with COPD.
Topics: Adrenergic beta-2 Receptor Agonists; Bronchodilator Agents; Cholinergic Antagonists; Humans; Muscarinic Antagonists; Pulmonary Disease, Chronic Obstructive
PubMed: 29305841
DOI: 10.1016/j.amjmed.2017.12.018