Long-acting anticholinergics in the treatment of asthmaGuyer, Autumn Chandler; Long, Aidan AngeloCurrent Opinion in Allergy and Clinical Immunology: August 2013 - Volume 13 - Issue 4 - p 392–398 doi: 10.1097/ACI.0b013e328362a775 PHARMACOTHERAPY AND EVIDENCE BASED MEDICINE: Edited by David Khan and Enrico Compalati Abstract Author Information Purpose of review The use of anticholinergic medications is well established as maintenance therapy for chronic obstructive pulmonary disease (COPD). There is a growing interest in the use of anticholinergic medications in the treatment of moderate to severe asthma. The purpose of this review is to summarize the scientific evidence for the use of anticholinergic therapy in the management of asthma. Recent findings Early case reports and small studies evaluated the use of the anticholinergic agent, tiotropium bromide, as maintenance therapy in asthma. Included in this review are several recent clinical trials which provide additional evidence for the use of tiotropium as add-on therapy for asthma. The use of tiotropium was demonstrated to be superior to doubling the dose of an inhaled corticosteroid (ICS) and more effective than placebo based on change in morning peak expiratory flow (PEF). Two large multinational trials provide evidence for the use of tiotropium in a subset of asthmatic patients who have not achieved control using combination therapy with an ICS and a long-acting β2 agonist (LABA). Summary The use of the long-acting anticholinergic agent, tiotropium, as maintenance of therapy in asthma, has been shown to be effective in some patients with moderate to severe asthma who are uncontrolled on combination therapy with ICS and LABA. Further studies are needed to better define which phenotypic subset of patients would benefit from the use of tiotropium. Massachusetts General Hospital, Boston, Massachusetts, USA Correspondence to Aidan Angelo Long, MD, Massachusetts General Hospital, 55 Fruit Street, Cox 201, Boston, MA 02114, USA. E-mail: Aalong@partners.org Copyright © 2013 Wolters Kluwer Health, Inc. All rights reserved.