Aclidinium bromide

How it works

It blocks muscarinic M3 receptors on airway smooth muscle, reducing cholinergic bronchoconstriction and producing sustained bronchodilation. Its design favours airway selectivity with limited systemic exposure.

Prescribing in practice

• As an antimuscarinic it can precipitate acute angle-closure glaucoma and urinary retention, so use cautiously in patients with glaucoma or bladder-outflow obstruction and advise on warning symptoms — the foremost safety point.
• It is for regular maintenance only and must not be used to relieve sudden breathlessness, for which a short-acting reliever is needed.
• Paradoxical bronchospasm can occur immediately after inhalation; if it does, stop the inhaler and reassess therapy.

Monitoring

Review inhaler technique, symptom control and exacerbation frequency at follow-up, checking for antimuscarinic adverse effects.

Counselling the patient

• Use it every day for prevention, not to relieve a sudden attack.
• Seek advice if vision becomes painful or blurred or passing urine becomes difficult.
• Demonstrate and keep good dry-powder inhaler technique.

Evidence & guidelines

Randomised trials show aclidinium improves lung function, symptoms and quality of life in COPD, supporting NICE-endorsed LAMA maintenance therapy.