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Anticholinergics prevent the increases in intracellular concentration of cyclic guanosine monophosphate (cyclic GMP) that are caused by interaction of acetylcholine with the muscarinic receptor on bronchial smooth muscle.

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In the last 5 years, metaanalyses of children () and adults () in randomized control trials have implied that IP given together or sequentially with adrenergic agonists enhances lung function and reduces admissions more than sympathomimetics alone.

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