Clinical Guidelines for Long-Term COPD Care | LONHALA® MAGNAIR® (glycopyrrolate)

Clinical Recommendation Highlights

GOLD recommends the use of long-acting bronchodilators for COPD maintenance therapy

The ABCD assessment tool1

*CAT is the intellectual property of GlaxoSmithKline. 

COPD patients in all groups may benefit from a long-acting bronchodilator1

  • Inhaled therapy is preferred over oral therapy
  • Prescribe a long-acting bronchodilator for maintenance treatment, with a goal to manage symptoms
  • Use of short-acting bronchodilators for maintenance treatment is generally not recommended
  • The use of inhaled corticosteroids has been associated with a higher prevalence of pneumonia in people with COPD
  • Inhalation-device education and technique training are essential to symptom management

According to GOLD, >2/3 of patients in clinical practice make at least one error using an inhalational device

GOLD does not endorse any specific treatments.

GOLD=Global Initiative for Chronic Obstructive Lung Disease.

©2019 Global Strategy for Diagnosis, Management, and Prevention of COPD. All rights reserved. Use is by express license from the owner.


AMDA recommends that most LTC residents with COPD should be treated with long-acting maintenance bronchodilators2*

"Bronchodilators, especially the long-acting forms, are underutilized in PA/LTC."§ — AMDA, 2016

*AMDA does not endorse any specific treatments.
Quality of evidence ratings defined as High=at least 1 randomized controlled trial OR 3 pre/post interventions or other prospective interventions, or 3 well-structured, relevant observational studies; Moderate=studies that use well-tested methods to make comparisons in a fair way, but where the results leave room for uncertainty (eg, because of the size of the study, losses to follow-up, or the method used for selecting groups for comparison); Low=studies in which the results are doubtful because the study design does not guarantee that fair comparisons can be made.
Strength of recommendation defined as: strong=benefits clearly outweigh risks; weak=benefits are balanced with risks; insufficient=evidence is inadequate to make a recommendation.
§From a retrospective analysis of more than 126,000 nursing home residents.

AMDA=AMDA – The Society for Post-Acute and Long-Term Care Medicine;

1. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: 2019 report. Global Initiative for Chronic Obstructive Lung Disease (GOLD). 2019:1-139.
2. AMDA - The Society for Post-Acute and Long-Term Care Medicine. COPD Management in the Post-Acute and Long-Term Care Setting Clinical Practice Guideline. Columbia, MD: AMDA 2016.

Important Safety Information & Indication

Important Safety Information

LONHALA MAGNAIR is contraindicated in patients with a hypersensitivity to glycopyrrolate or to any of the ingredients.

LONHALA MAGNAIR should not be initiated in patients with acutely deteriorating or potentially life-threatening episodes of COPD or used as rescue therapy for acute episodes of bronchospasm. Acute symptoms should be treated with an inhaled short-acting beta2-agonist.

As with other inhaled medicines, LONHALA MAGNAIR can produce paradoxical bronchospasm that may be life-threatening. If paradoxical bronchospasm occurs following dosing with LONHALA MAGNAIR, it should be treated immediately with an inhaled, short-acting bronchodilator; LONHALA MAGNAIR should be discontinued immediately and alternative therapy instituted.

Immediate hypersensitivity reactions have been reported with LONHALA MAGNAIR. If signs occur, discontinue LONHALA MAGNAIR immediately and institute alternative therapy.

LONHALA MAGNAIR should be used with caution in patients with narrow-angle glaucoma and in patients with urinary retention. Prescribers and patients should be alert for signs and symptoms of acute narrow-angle glaucoma (e.g., eye pain or discomfort, blurred vision, visual halos or colored images in association with red eyes from conjunctival congestion and corneal edema) and of urinary retention (e.g., difficulty passing urine, painful urination), especially in patients with prostatic hyperplasia or bladder-neck obstruction. Patients should be instructed to consult a physician immediately should any of these signs or symptoms develop.

The most common adverse events reported in ≥2% of patients taking LONHALA MAGNAIR, and occurring more frequently than in patients taking placebo, were dyspnea (4.9% vs 3.0%) and urinary tract infection (2.1% vs 1.4%).

LONHALA solution is for oral inhalation only and should not be injected or swallowed. LONHALA vials should only be administered with MAGNAIR.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit or call 1-800-FDA-1088.

For additional information, please see full Prescribing Information and Patient Information for LONHALA MAGNAIR at


LONHALA® MAGNAIR® (glycopyrrolate) is an anticholinergic indicated for the long-term maintenance treatment of airflow obstruction in patients with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and/or emphysema.