Corticosteroids: potential beta2-agonist and anticholinergic interactions in chronic obstructive pulmonary disease

Proc Am Thorac Soc. 2005;2(4):320-5; discussion 340-1. doi: 10.1513/pats.200504-040SR.


Corticosteroids are often used in combination with beta2-agonist and anticholinergic bronchodilators in the treatment of chronic obstructive pulmonary disease (COPD). Corticosteroids activate the beta2-receptor gene, increasing receptor number and decreasing desensitization. Long-acting beta2-agonists prime the glucocorticoid receptor and enhance nuclear translocation via activation of CCAAT enhancer binding protein-alpha. Corticosteroids can also increase prejunctional auto-inhibitory M2-receptor gene expression in airway smooth muscle. There is evidence of a synergistic inhibition of cytokine and chemokine release from alveolar macrophages, epithelial cells, and mucosal glands and enhanced respiratory cytoprotection against viral and bacterial infection when a corticosteroid is combined with salmeterol. In airway smooth muscle, corticosteroids inhibit the contractile effects of acetylcholine, whereas M2-receptor antagonism increases the relaxant activity of isoproterenol. Complementary interactions between corticosteroids and long-acting beta2-agonists and between corticosteroids and anticholinergic bronchodilators may be important if these drugs are combined in the treatment of COPD.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Adrenal Cortex Hormones / administration & dosage*
  • Adrenal Cortex Hormones / pharmacology
  • Adrenergic beta-Agonists / administration & dosage*
  • Adrenergic beta-Agonists / pharmacology
  • Animals
  • Bronchodilator Agents / administration & dosage*
  • Bronchodilator Agents / pharmacology
  • Cholinergic Antagonists / administration & dosage*
  • Cholinergic Antagonists / pharmacology
  • Drug Interactions
  • Drug Therapy, Combination
  • Humans
  • Pulmonary Disease, Chronic Obstructive / drug therapy*
  • Pulmonary Disease, Chronic Obstructive / metabolism
  • Receptors, Adrenergic, beta-2 / drug effects
  • Receptors, Glucocorticoid / drug effects
  • Receptors, Muscarinic / drug effects


  • Adrenal Cortex Hormones
  • Adrenergic beta-Agonists
  • Bronchodilator Agents
  • Cholinergic Antagonists
  • Receptors, Adrenergic, beta-2
  • Receptors, Glucocorticoid
  • Receptors, Muscarinic