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

机译：抗胆碱能药物治疗成人和儿童哮喘的未来前景

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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 βsub2/sub-agonists at GINA Steps 4 and 5 with a history of exacerbations. Evidence supports the efficacy of tiotropium Respimatsup?/sup 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.
机译：尽管在治疗干预方面取得了重大进展并且提供了详细的治疗指南，但仍有很大一部分症状性哮喘患者无法控制。哮喘的管理很大程度上受全球哮喘倡议（GINA）的指导，并基于吸入性糖皮质激素（ICS）治疗的基础，并使用其他疗法来控制疾病。吸入长效支气管扩张剂单独或联合使用是首选的附加治疗方案。尽管长效毒蕈碱拮抗剂（LAMAs）是哮喘疾病管理建议中相对较新的补充，但噻托溴铵已在大型临床试验计划中得到了广泛研究。在欧洲和美国，噻托溴铵已被批准用于年龄≥6岁且在GINA步骤4和5中不受中高剂量ICS /长效β 2 激动剂控制的患者，并有病史恶化。有证据支持噻托溴铵Respimat ？在成年人的肺功能和哮喘控制方面的功效，其安全性在各种哮喘严重程度下均与安慰剂相当。同样，在1至17岁的患者中进行的临床试验显示，肺功能得到改善，哮喘控制得到改善。此外，其功效使得噻托溴铵相对容易纳入常规临床实践，而与过敏状态无关，并且不需要患者表型。噻托溴铵是一种经济有效的治疗方法，可以提供其他更昂贵的附加疗法的重要替代方案。这篇综述通过考虑不断发展的证据讨论了LAMA在临床实践中的潜在未来地位。噻托溴铵（Tiotropium）是迄今为止最受哮喘的结构化临床试验计划支持的唯一LAMA，同时也考虑了其他不受哮喘控制的推荐治疗方案。还强调了有效的患者/护理人员-临床医生沟通和共同决策对增强治疗依从性的重要性。

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