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Future perspectives of anticholinergics for the treatment of asthma in adults and children

Authors Buhl R, Hamelmann E

Received 20 July 2018

Accepted for publication 12 November 2018

Published 14 March 2019 Volume 2019:15 Pages 473—485


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Editor who approved publication: Professor Garry Walsh

Video summary of review paper "Future perspectives of anticholinergics for the treatment of asthma in adults and children".

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Roland Buhl,1 Eckard Hamelmann2,3

1Pulmonary Department, Johannes Gutenberg University Hospital Mainz, Mainz, Germany; 2Children’s Center Bethel, Evangelic Hospital Bethel, Department of Pediatrics, Bielefeld, Germany; 3University Children’s Hospital, Allergy Center Ruhr, Ruhr University Bochum, Bochum, Germany

Abstract: Despite major advances in therapeutic interventions and the availability of detailed treatment guidelines, a high proportion of patients with symptomatic asthma remain uncontrolled. Asthma management is largely guided by the Global Initiative for Asthma (GINA) strategy and is based on a backbone of inhaled corticosteroid (ICS) therapy with the use of additional therapies to achieve disease control. Inhaled long-acting bronchodilators alone and in combination are the preferred add-on treatment options. Although long-acting muscarinic antagonists (LAMAs) are a relatively recent addition to disease management recommendations for asthma, tiotropium has been extensively studied in a large clinical trial program. In Europe and the United States, tiotropium is approved for patients aged ≥6 years and uncontrolled on medium- to high-dose ICS/long-acting β2-agonists at GINA Steps 4 and 5 with a history of exacerbations. Evidence supports the efficacy of tiotropium Respimat® in adults in terms of lung function and asthma control, with a safety profile comparable with that of placebo across a range of asthma severities. Similarly, clinical trials in patients aged 1–17 years have shown improvements in lung function and trends toward improved asthma control. Furthermore, its efficacy makes tiotropium relatively easy to incorporate into routine clinical practice, irrespective of allergic status and without the need for patient phenotyping. Tiotropium is a cost-effective treatment that may offer an important alternative to other, more expensive add-on therapies. This review discusses the potential future position of LAMAs in clinical practice by considering the continuously evolving evidence. Prominence is given to tiotropium, the only LAMA supported by a structured clinical trial program in asthma to date, while also considering other recommended treatment options for patients with uncontrolled asthma. The importance of effective patient/caregiver–clinician communication and shared decision-making in enhancing treatment adherence is also highlighted.

Keywords: asthma, anticholinergic, tiotropium, LAMA, asthma management, adherence, pediatric asthma

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