Umeclidinium

How it works

It blocks muscarinic M3 receptors on airway smooth muscle, inhibiting acetylcholine-mediated bronchoconstriction to produce sustained bronchodilation.

Prescribing in practice

• It is a maintenance bronchodilator only and is not suitable for the relief of acute bronchospasm; patients must retain a short-acting reliever inhaler.
• Use with caution in patients with narrow-angle glaucoma or significant urinary retention or bladder outflow obstruction owing to its antimuscarinic effects.
• It is available as a dry powder inhaler and as a fixed-dose combination with a long-acting beta-2 agonist; avoid duplicating LAMA therapy.

Monitoring

Monitor symptom control, exacerbation frequency and inhaler technique, and watch for antimuscarinic effects such as dry mouth, worsening glaucoma or urinary retention.

Counselling the patient

• This inhaler is for regular daily use to prevent symptoms, not for sudden breathlessness; keep your reliever inhaler with you.
• Report blurred vision, eye pain, or difficulty passing urine.
• Rinse your mouth and check your inhaler technique to get the full benefit.

Evidence & guidelines

NICE guidance on COPD supports long-acting bronchodilators including LAMAs for maintenance treatment to reduce symptoms and exacerbations.