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May caus uinay tntion; us with caution in patints with bnign postatic hypplasia (BPH) bladd-nck obstuction.

Jay W. Maks, MD, is a boad-ctiid intnist and gastontologist. H gaduatd om Yal Univsity School Mdicin and taind in intnal mdicin and gastontology at UCLA/Cdas-Sinai Mdical Cnt in Los Angls.

In tatmnt acut asthma xacbation with inhal, shot-acting bta agonist (SABA) must b coadministd.

Ipatopium bomid is a quatnay ammonium compound with anticholingic (paasympatholytic) poptis. In nonclinical studis, it appas tinhibit vagally mdiatd lxs by antagonising th action actylcholin, th tansmitt agnt lasd om th vagus nv. Anticholingics pvnt th incas in intacllula concntation Ca++ which is causd by intaction actylcholin with th muscainic cpton bonchial smooth muscl. Ca++ las is mdiatd by th scond mssng systm consisting IP3 (inositol tiphosphat) and DAG (diacylglycol).

Most COPD patints, th mdicin in Atovnt HA stats impoving lung unction within about 15 minuts. Atovnt HA taks about th tims long than albutol tstat woking. this ason, it is not commndd us as a scu inhal.

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