Introduction: The role of long-acting muscarinic antagonists (LAMAs) is well established in uncontrolled asthma, but not in milder stages.
Areas covered: This review examines the main randomized controlled trials (RCTs) that have investigated LAMAs administered as monotherapy or in combination to asthmatic patients, according to the different phenotypes. It offers an overview of the role of LAMAs or their fixed dose combinations (FDCs) in the treatment across all the different stages of asthma.
Expert opinion: Tiotropium is now widely recognized as treatment for moderate to severe uncontrolled asthma (step 4-5) in adults and children. The most recent new evidence is: a) in adults, three different LAMA/long-acting β2-agonist (LABA)/inhaled corticosteroid (ICS) FDCs have been recently approved, extending the treatment options for these patients; b) therapy with LAMAs does not depend on patient's Th2 status and justifies the indication regardless of patient's phenotyping; c) in the milder stages, the high variability of response to LAMAs and the lack of a good phenotyping of patients represents the main obstacle in prescribing LAMAs. A better characterization of parasympathetic tone activity could improve LAMAs prescription.
Keywords: LAMA; Long-acting muscarinic antagonist; asthma; glycopyrronium bromide; tiotropium bromide; triple therapy; umeclidinium bromide.
Muiser S, Gosens R, van den Berge M, Kerstjens HAM. Muiser S, et al. Ann Allergy Asthma Immunol. 2022 Apr;128(4):352-360. doi: 10.1016/j.anai.2021.12.020. Epub 2022 Jan 21. Ann Allergy Asthma Immunol. 2022. PMID: 35074516 Review.
Luz MI, Aguiar R, Morais-Almeida M. Luz MI, et al. Expert Rev Respir Med. 2020 Nov;14(11):1087-1094. doi: 10.1080/17476348.2020.1794828. Epub 2020 Jul 20. Expert Rev Respir Med. 2020. PMID: 32687426
Papi A, Fabbri LM, Kerstjens HAM, Rogliani P, Watz H, Singh D. Papi A, et al. Eur J Intern Med. 2021 Mar;85:14-22. doi: 10.1016/j.ejim.2021.01.027. Epub 2021 Feb 6. Eur J Intern Med. 2021. PMID: 33563506 Review.
Ferguson GT, Darken P, Ballal S, Siddiqui MK, Singh B, Attri S, Holmgren U, de Nigris E. Ferguson GT, et al. Adv Ther. 2020 Jun;37(6):2956-2975. doi: 10.1007/s12325-020-01311-3. Epub 2020 Apr 25. Adv Ther. 2020. PMID: 32335859 Free PMC article.
Thomson NC. Thomson NC. Expert Opin Pharmacother. 2017 Feb;18(3):283-293. doi: 10.1080/14656566.2017.1284794. Epub 2017 Feb 1. Expert Opin Pharmacother. 2017. PMID: 28099820 Review.
Yuan HK, Lu J, Wang XL, Lv ZY, Li B, Zhu W, Yang YQ, Yin LM. Yuan HK, et al. Front Pharmacol. 2022 Jun 16;13:873612. doi: 10.3389/fphar.2022.873612. eCollection 2022. Front Pharmacol. 2022. PMID: 35784706 Free PMC article.