Cardio-Thoracic and Vascular Department, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy.
Expert Rev Respir Med. 2012 Jun;6(3):309-19. doi: 10.1586/ers.12.27.
Although bronchial hyperresponsiveness to cholinergic agents is a main feature of asthma, the role of anticholinergic drugs in chronic asthma management has been largely underestimated. Several single-dose studies comparing acute bronchodilation induced by ipratropium bromide with salbutamol have shown that salbutamol was more effective than ipratropium in asthma treatment. Recently, tiotropium has been studied in asthma, when added to low-dose inhaled corticosteroids in unselected moderate asthmatics or in patients with uncontrolled asthma, or patients with chronic obstructive pulmonary disease and history of asthma. Later, studies on patients with Arg/Arg β(2)-receptor polymorphism demonstrated a similar efficacy of tiotropium in comparison with salmeterol when both were added to low-dose inhaled corticosteroids. Further long-term studies are currently in progress, for the evaluation of the efficacy of tiotropium on clinical asthma control, and on the rate and severity of asthma exacerbations, as well as the potential modification of inflammatory mechanisms and varying efficacy in specific asthma phenotypes (such as smoking asthmatics).
虽然气道对胆碱能药物的高反应性是哮喘的主要特征之一，但抗胆碱能药物在慢性哮喘管理中的作用在很大程度上被低估了。几项单剂量研究比较了溴化异丙托品和沙丁胺醇引起的急性支气管扩张作用，结果表明在哮喘治疗中，沙丁胺醇比异丙托品更有效。最近，噻托溴铵已在哮喘中进行了研究，当添加到低剂量吸入皮质激素中时，可用于未选择的中度哮喘患者或未控制的哮喘患者，或慢性阻塞性肺疾病和哮喘病史的患者。后来，对 Arg/Arg β(2)-受体多态性患者的研究表明，当噻托溴铵和沙美特罗都添加到低剂量吸入皮质激素中时，其疗效相似。目前正在进行进一步的长期研究，以评估噻托溴铵对临床哮喘控制的疗效，以及哮喘加重的频率和严重程度，以及炎症机制的潜在改变和在特定哮喘表型（如吸烟哮喘患者）中的不同疗效。
