Busse William W, Dahl Ronald, Jenkins Christine, Cruz Alvaro A
University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
Allergy Centre, Odense University Hospital, Odense, Denmark.
Eur Respir Rev. 2016 Mar;25(139):54-64. doi: 10.1183/16000617.0052-2015.
Asthma is a chronic inflammatory disorder of the airways that is a major global burden on both individuals and healthcare systems. Despite guideline-directed treatment, a significant proportion of patients with asthma do not achieve control. This review focuses on the potential use of long-acting anticholinergics as bronchodilators in the treatment of asthma, with results published from clinical trials of glycopyrrolate, umeclidinium and tiotropium. The tiotropium clinical trial programme is the most advanced, with data available from a number of phase II and III studies of tiotropium as an add-on to inhaled corticosteroid maintenance therapy, with or without a long-acting β2-agonist, in patients across asthma severities. Recent studies using the Respimat Soft Mist inhaler have identified 5 µg once daily as the preferred dosing regimen, which has shown promising results in adults, adolescents and children with asthma. Tiotropium Respimat has recently been incorporated into the Global Initiative for Asthma 2015 treatment strategy as a recommended alternative therapy at steps 4 and 5 in adult patients with a history of exacerbations. The increasing availability of evidence from ongoing and future clinical trials will be beneficial in determining where long-acting anticholinergic agents fit in future treatment guidelines across a variety of patient populations and disease severities.
哮喘是一种气道慢性炎症性疾病，对个人和医疗保健系统都是一项重大的全球负担。尽管有指南指导的治疗，但仍有相当一部分哮喘患者未实现病情控制。本综述聚焦于长效抗胆碱能药物作为支气管扩张剂在哮喘治疗中的潜在应用，并介绍了格隆溴铵、乌美溴铵和噻托溴铵临床试验的结果。噻托溴铵的临床试验项目最为先进，有多项II期和III期研究的数据，这些研究涉及在不同严重程度的哮喘患者中，将噻托溴铵作为吸入性糖皮质激素维持治疗的附加药物，联合或不联合长效β2受体激动剂使用。最近使用Respimat软雾吸入器的研究确定每日一次5微克为首选给药方案，该方案在患有哮喘的成人、青少年和儿童中已显示出有前景的结果。噻托溴铵Respimat最近已被纳入《全球哮喘防治创议》2015治疗策略，作为有加重病史的成年患者在第4和第5步的推荐替代疗法。来自正在进行和未来临床试验的证据越来越多，这将有助于确定长效抗胆碱能药物在不同患者群体和疾病严重程度的未来治疗指南中的适用情况。
