The reality of LAMAs for adult asthmatic patients

ABSTRACT

Introduction

The use of tiotropium is approved for the treatment of asthma. There are several studies completed or currently ongoing with the long-acting muscarinic antagonists (LAMAs) umeclidinium and glycopyrronium as an add-on asthma treatment. Adding a second bronchodilator with a different mechanism of action for the treatment of uncontrolled asthma may be a suitable therapeutic approach, although several issues still under discussion.

Areas covered

The reality of LAMA plus long-acting beta-agonists (LABA) treatment for adult asthma. A systematic search was conducted on March 2020, and included 6 electronic databases: EMBASE, MEDLINE, Scopus, The Cochrane Library, Web of Science and Google Scholar.

Expert opinion

A growing body of evidence generated from several randomized clinical trials is supporting the use of LAMA in adulthood asthma always in association with inhaled corticosteroid (ICS). Currently, only tiotropium has been approved and included in the guidelines. Other LAMAs are under evaluation in clinical trials. Several clinical trials are supporting the use of a triple therapy (ICS/LABA/LAMA) in uncontrolled asthmatic patients under ICS/LABA

KEYWORDS:

• Asthma
• inhaled corticosteroids
• long-acting β2-agonists
• long-acting muscarinic antagonists
• triple therapy

Article highlights

• Asthma is a chronic inflammatory disease of the airways that affects over 300 million people worldwide. Despite the use of current therapies, surveys indicate that 45% of European have poorly controlled symptoms and experience frequent exacerbations.

• The Global Initiative for Asthma (GINA) strategy recommends a stepwise approach in the treatment of asthma, building on a base of inhaled corticosteroids (ICS) to achieve asthma control and reduce future risk.

• Tiotropium, an anticholinergic treatment, is included in the guidelines as an add-on therapeutic option at GINA Steps 4 and 5 in patients with a history of asthma exacerbations.

• LAMAS umeclidinium and glycopyrronium are under development in fixed-dose combination with ICS and LABA in patients with uncontrolled severe asthma.

• Single-inhaler triple therapy with an inhaled corticosteroid (ICS), a long-acting beta-agonist (LABA), and a long-acting muscarinic antagonist improved lung function and reduced exacerbations in patients with asthma poorly controlled with ICS and LABA combined treatment, according several clinical trials.

Acknowledgments

Both Maria Inês Luz and Rita Aguiar contributed equally to this manuscript.

Declaration of interest

The authors have no 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. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

A reviewer has performed consulting, served on advisory boards, or received travel reimbursement from Amphastar, AstraZeneca, Boehringer Ingelheim, Cipla, Chiesi, GlaxoSmithKline, Mylan, Novartis, Pearl, Sunovion and Theravance. They have conducted multicenter clinical research trials for some 40 pharmaceutical companies. Peer reviewers on this manuscript have no other relevant financial or other relationships to disclose.

Data availability

Articles used in this review were retrieved from PubMed, Google Scholar, The Cochrane Library, MEDLINE. Ongoing or completed clinical trials were obtained through clinicaltrials.gov.

Additional information

Funding

This paper was not funded.