Raissy Hengameh H, Kelly H William
Department of Pediatrics, MSC10 5590, Clinical and Translational Science Center, University of New Mexico, School of Medicine, 1 University of New Mexico, Albuquerque, NM, 87131, USA.
Pediatrics UNMHSC, 9828 Guadalupe Trail NW, Albuquerque, NM, 87114-2009, USA.
Paediatr Drugs. 2017 Dec;19(6):533-538. doi: 10.1007/s40272-017-0258-9.
Evidence is emerging on the use of long-acting muscarinic antagonists (LAMAs) in the management of asthma. Tiotropium bromide (Spiriva Respimat) is the only LAMA approved in children and adolescents. As the use of tiotropium becomes more common in clinical practice, it is necessary to review the existing data to identify patients who may benefit from the addition of this medication to their daily asthma regimen. This review discusses recent evidence on the safety and efficacy of tiotropium bromide in the management of asthma in children and adolescents. Current data support that tiotropium bromide has a bronchodilator effect, as evident by improvements in acute lung function compared with placebo; however, data are not yet available to present a stepwise approach or identify phenotypes that would benefit from the addition of tiotropium bromide. Well-designed studies are needed to compare the different step-up options to tiotropium bromide and provide an evidence-based stepwise approach for the management of asthma in children. Furthermore, study design should include identification of phenotypes that might experience a better clinical response to tiotropium bromide compared with other adjunct medications.
长效毒蕈碱拮抗剂（LAMA）用于哮喘管理的证据正在不断涌现。噻托溴铵（思力华能倍乐）是唯一被批准用于儿童和青少年的LAMA。随着噻托溴铵在临床实践中的使用越来越普遍，有必要回顾现有数据，以确定哪些患者可能从将这种药物添加到日常哮喘治疗方案中获益。本综述讨论了噻托溴铵治疗儿童和青少年哮喘的安全性和有效性的最新证据。目前的数据支持噻托溴铵具有支气管扩张作用，与安慰剂相比，急性肺功能的改善就证明了这一点；然而，目前尚无数据提供逐步治疗方法或确定可从添加噻托溴铵中获益的表型。需要进行精心设计的研究，以比较不同的升级至噻托溴铵的方案，并为儿童哮喘管理提供基于证据的逐步治疗方法。此外，研究设计应包括识别与其他辅助药物相比，可能对噻托溴铵有更好临床反应的表型。
