The inhaled long-acting anticholinergic (also known as an antimuscarinic bronchodilator) tiotropium is used in the management of chronic obstructive pulmonary disease (COPD).

Dosage regimen

* Tiotropium inhalers are usually used once a day.

Patient's knowledge of the medicine's use

* Anticholinergics reduce breathlessness, bronchoconstriction and mucus secretion. Long-acting agents may be used if the patient remains symptomatic or has had experienced two or more exacerbations in a year and a long-acting beta2 agonist has failed.

Is the medicine working?

* Asking the following questions will show how effective drug treatment is, and the impact the condition has on the patient's life:

* Has your breathing improved?

* How often do you experience shortness of breath?

* Does COPD affect your social or family life?

* Do you sleep well at night?

Side effects

* Anticholinergics commonly cause a cough, a dry mouth, nausea and constipation.

Monitoring

* Ensure the patient can recognise the signs of an exacerbation, and has standby oral corticosteroids and antibiotics.

Lifestyle

* Encourage the patient to lose or increase weight (depending on the situation).

* Encourage smokers to stop smoking as this is an important factor in the progression of COPD.

* Pulmonary rehabilitation can be used to improve social and physical performance.

* Patients can also try psychotherapy, family therapy or counselling.

Uzma Chaudhry, relief pharmacist, Lloydspharmacy, Oxfordshire / AF

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