Antimuscarinics (SAMA / LAMA)

respiratory bronchodilator antimuscarinic

Antimuscarinics bronchodilate by blocking vagal bronchoconstriction rather than stimulating dilation.

They are the foundation maintenance bronchodilators in COPD and adjunct therapy in asthma.

These medications are a respiratory application of muscarinic receptor blockade.


Drugs in Class

Short-Acting (SAMA)

Long-Acting (LAMA)


Mechanism of Action

Receptor Blocked

(see Autonomic Antimuscarinics)

Normal Physiology

Drug Effect

Net effect:


Clinical Role

Primary therapy:

Adjunct therapy:

Often combined with:


Onset and Duration

Class Onset Duration Clinical Role
SAMA ~15 min ~6 hr Exacerbation adjunct
LAMA 30–60 min 24+ hr Maintenance therapy

Adverse Effects

Effect Mechanism
Dry mouth Reduced secretions
Urinary retention Bladder detrusor inhibition
Blurred vision Ocular exposure
Constipation GI smooth muscle inhibition

Minimal systemic absorption due to inhaled route.


Contraindications


Clinical Pearls

COPD is primarily cholinergic-mediated bronchoconstriction → LAMA therapy is foundational treatment


Comparison Within Bronchodilators

Drug Class Mechanism Best Disease Target
β2 agonists Stimulate dilation Asthma
Antimuscarinics Block constriction COPD