The European Commission granted a marketing authorisation valid throughout the European Union for Incruse (umeclidinium bromide) on 28 April 2014. It is used to relieve the symptoms of chronic obstructive pulmonary disease (COPD) in adults. COPD is a long-term disease in which the airways and air sacs inside the lungs become damaged or blocked, leading to difficulty breathing. Incruse is used for maintenance (regular) treatment. Umeclidinium bromide is a muscarinic receptor antagonist. It works by blocking some receptors called muscarinic receptors, which control the contraction of muscles. When umeclidinium bromide is inhaled, it causes the muscles of the airways to relax, helping to keep the airways open and allowing the patient to breathe more easily. Incruse was investigated in four main studies involving over 4,000 patients. Results showed that Incruse at a dose of equivalent to 55 micrograms of umeclidinium improved lung function by an average FEV1 by 127 ml more than placebo after 12 weeks of treatment and by 115 ml after 24 weeks of treatment. Incruse given at double that dose only showed small improvements compared with the lower dose, which were not considered relevant. In the study comparing Incruse with tiotropium, FEV1 improvements over 24 weeks were similar for both medicines. The most common side effects with Incruse (seen in between 1 and 10 patients in 100) are headache, nasopharyngitis (inflammation of the nose and throat) and upper respiratory tract infection (cold). Incruse is available as an inhalation powder in a portable inhaler device. The inhaler delivers 65 micrograms of umeclidinium bromide equivalent to 55 micrograms of umeclidinium for each inhalation.