Aalbers René, Park Hae Sim
Department of Pulmonology, Martini Hospital, Groningen, The Netherlands.
Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea.
Allergy Asthma Immunol Res. 2017 Sep;9(5):386-393. doi: 10.4168/aair.2017.9.5.386.
Despite a range of efficacious therapies for asthma, including inhaled corticosteroids (ICS) and long-acting β₂-agonists (LABA), a significant proportion of patients have poor asthma control and retain a risk of future worsening of their symptoms. Long-acting muscarinic antagonist (LAMA) bronchodilators offer a well-tolerated, efficacious, and cost-effective add-on to a patient's treatment. Of the LAMAs currently under investigation or available for the treatment of asthma, evidence from a comprehensive clinical trial program in adults and children shows that once-daily treatment with tiotropium provides benefits for patients with uncontrolled asthma despite the use of ICS and LABAs. Tiotropium is included in the Global Initiative for Asthma (GINA) strategy document as an add-on therapy option for patients at Step 4 or 5 with a history of asthma exacerbations. Tiotropium Respimat® has demonstrated safety and efficacy in patients with a range of disease severities, ages, and phenotypes. This review describes the evidence for the use of LAMA as add-on therapy for patients with asthma who remain uncontrolled despite the use of ICS and LABA treatments.
尽管有一系列治疗哮喘的有效疗法，包括吸入性糖皮质激素（ICS）和长效β₂受体激动剂（LABA），但仍有相当一部分患者哮喘控制不佳，且未来症状有加重的风险。长效毒蕈碱拮抗剂（LAMA）支气管扩张剂为患者的治疗提供了耐受性良好、有效且具有成本效益的附加治疗方案。在目前正在研究或可用于治疗哮喘的LAMA中，一项针对成人和儿童的全面临床试验项目的证据表明，对于尽管使用了ICS和LABA但哮喘仍未得到控制的患者，噻托溴铵每日一次治疗能带来益处。噻托溴铵被纳入全球哮喘防治创议（GINA）战略文件，作为有哮喘加重史的4级或5级患者的附加治疗选择。噻托溴铵软雾吸入剂（Tiotropium Respimat®）已在一系列疾病严重程度、年龄和表型的患者中证明了安全性和有效性。本综述描述了将LAMA作为附加疗法用于尽管使用了ICS和LABA治疗但仍未得到控制的哮喘患者的证据。
