Current guidelines recommend a stepwise approach for pharmacological therapy aimed to achieve and maintain asthma control. Despite these recommendations, at least 50% of patients continue to be uncontrolled with risk of asthma exacerbations that can often be serious and are associated with deterioration of quality of life. In recent years, the interest in anticholinergic bronchodilators, which have been primarily used in the treatment of chronic obstructive pulmonary disease, has increased patients with uncontrolled asthma. This review analyzes the mechanisms for the proposed clinical use of anticholinergic bronchodilators as an adjunctive therapy in asthma.
Based on existing and recent evidence, the use of anticholinergic bronchodilators, particularly long-acting muscarinic antagonists (LAMAs), plays an important role as add-on therapy in patients uncontrolled on existing therapies. In particular, the use of anticholinergics in asthma may have a role in patients intolerant to long-acting β2 agonist, in patients with certain pharmacogenetic profiles and in those patients with asthma symptoms mostly at night.
Data from clinical trials and from real-life confirm the safety and efficacy of LAMAs, especially tiotropium, in patients who remain uncontrolled despite the use of inhaled corticosteroid therapy.
aDepartment of Pneumology, ‘Federico II University’, AO ‘Dei Colli’ Monaldi Hospital
bRespiratory Department, University of Naples Federico II
cDivision of Respiratory Medicine and Allergy, Department of Respiratory Diseases, High Specialty Hospital ‘A. Cardarelli’
dUniversity of Naples Federico II, School of Specialization in Respiratory Diseases, Naples, Italy
Correspondence to Maria D’Amato, MD, PhD, Department of Pneumology, ‘Federico II University’, AO ‘Dei Colli’ Monaldi Hospital, Naples, Italy. Tel: +39 3356697377; fax: +39 081 5454321; e-mail: firstname.lastname@example.org