Role of muscarinic antagonists in asthma therapy

ABSTRACT

Introduction: Higher parasympathetic tone has been reported in asthmatics. In general, cholinergic contractile tone is increased by airway inflammation associated with asthma. Nevertheless, the role of muscarinic antagonists for the treatment of asthma has not yet been clearly defined.

Areas covered: The use of SAMAs and LAMAs in asthma has been examined and discussed according with the published evidence. Particular attention has been given to the large Phase III clinical trial program designed to evaluate the efficacy and safety of tiotropium respimat added to standard treatment in adults, adolescents and children with persistent asthma across the spectrum of asthma severity.

Expert commentary: The current evidence is that in patients with poorly controlled severe asthma despite the use of ICS and LABA, the addition of tiotropium significantly increases the time to the first severe exacerbation and provides a modest but sustained bronchodilation. Identical results should be produced using other LAMAs. In any case, the documentation that, at least in animal or in vitro models, LAMAs show significant anti-inflammatory and anti-proliferative capacities and are able to inhibit airway remodeling induced by allergens makes a strong presumption that the use of LAMAs in asthma may go beyond the simple bronchodilator effect.

KEYWORDS:

• Adults
• asthma
• children
• glycopyrronium
• long acting muscarinic antagonists
• parasympathetic tone
• short acting muscarinic antagonists
• tiotropium
• umeclidinium

Declaration of interest

M. Cazzola is a consultant for Novartis and Chiesi and a member of the speakers bureau for Novartis, Boehringer Ingelheim and AstraZeneca. P. Rogliani is a member of the speakers bureau for AstraZeneca, Chiesi Novartis and Boehringer Ingelheim. GM. Matera is a member of the speakers bureau for AstraZeneca and Boehringer Ingelheim. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

This paper was not funded.