Modern quaternary anticholinergic bronchodilators are descendants of the early botanical preparations of the nightshade family (Solanaceae). The stems, roots, and seeds of these plants contain alkaloids, which have been used for millennia in religious ceremonies, assassinations, recreational hallucinations, and medical remedies. Inhalation therapy for obstructive pulmonary disease with various compounds containing the belladonna alkaloids has been used for centuries. The effectiveness of these preparations can be attributed to their containing atropine, a tertiary ammonium structure. The use of these “medications” fell out of favor within the medical community in the early twentieth century with the development of long-acting methyxanthines and β2-agonists for obstructive disease. However, in the 1970s, the pharmaceutical industry developed synthetic congeners of atropine, which exhibited fewer systemic side effects. These newer quaternary ammonium compounds have reestablished the place of anticholinergic agents in the treatment of obstructive airways disease.