Inhaled long-acting muscarinic antagonists in asthma - A narrative review.

Abstract

Long-acting muscarinic antagonists (LAMAs) have a recognised role in the management of chronic obstructive pulmonary disease. In asthma, muscarinic antagonists (both short- and long-acting) were historically considered less effective than β2-agonists; only relatively recently have studies been conducted to evaluate the efficacy of LAMAs, as add-on to either inhaled corticosteroid (ICS) monotherapy or ICS/long-acting β2-agonist (LABA) combinations. These studies led to the approval of the first LAMA, tiotropium, as an add-on therapy in patients with poorly controlled asthma. Subsequently, a number of single-inhaler ICS/LABA/LAMA triple therapies have been approved or are in clinical development for the management of asthma. There is now substantial evidence of the efficacy and safety of LAMAs in asthma that is uncontrolled despite treatment with an ICS/LABA combination. This regimen is recommended by GINA as an optimisation step for patients with severe asthma before any biologic or systemic corticosteroid treatment is initiated. This narrative review summarises the potential mechanisms of action of LAMAs in asthma, together with the initial clinical evidence supporting this use. We also discuss the studies that led to the approval of tiotropium for asthma and the data evaluating the efficacy and safety of the various triple therapies, before considering other potential uses for triple therapy.

• Authors: Alberto Papi, Leonardo M Fabbri, Huib A M Kerstjens, Paola Rogliani, Henrik Watz, Dave Singh
• Journal: European journal of internal medicine (Eur J Intern Med) Vol. 85 Pg. 14-22 (Mar 2021) ISSN: 1879-0828 [Electronic] Netherlands
• PMID: 33563506 (Publication Type: Journal Article, Review)
• Copyright: Copyright © 2021. Published by Elsevier B.V.

Chemical References

• Adrenal Cortex Hormones
• Adrenergic beta-2 Receptor Agonists
• Bronchodilator Agents
• Muscarinic Antagonists

Topics

• Administration, Inhalation
• Adrenal Cortex Hormones (therapeutic use)
• Adrenergic beta-2 Receptor Agonists (therapeutic use)
• Asthma (drug therapy)
• Bronchodilator Agents (therapeutic use)
• Drug Therapy, Combination
• Humans
• Muscarinic Antagonists (therapeutic use)
• Pulmonary Disease, Chronic Obstructive (drug therapy)