McIvor Emma R, McIvor R Andrew
Queen's University, Belfast, UK.
Department of Medicine, McMaster University, Firestone Institute for Respiratory Health, Hamilton, Ontario, Canada.
J Asthma Allergy. 2017 Aug 14;10:231-236. doi: 10.2147/JAA.S140577. eCollection 2017.
Tiotropium is a long-acting muscarinic antagonist (LAMA) that exerts its bronchodilatory effect by blocking endogenous acetylcholine receptors in the airways. Its safety and efficacy are well established for the treatment of COPD, and it is now being recognized for its role in improving lung function and control in asthma. This review discusses the evolving role of tiotropium delivered by the Respimat in patients across the range of asthma severities and ages, and provides an overview of safety and efficacy data. Tiotropium is the only LAMA currently approved for the treatment of asthma, and evidence from a large-scale clinical trial program, including several Phase III studies in adults, has demonstrated that tiotropium improves lung function and asthma control, with a safety profile comparable with that of placebo. Clinical trials in adolescent patients (aged 12-17 years) have also shown improvements in lung function and trends toward improved asthma control. Of note, the efficacy and safety profiles are consistent regardless of baseline characteristics and phenotype. Given the large and growing body of evidence, it is likely that as clinical experience with tiotropium increases, this treatment may possibly emerge as the key choice for add-on therapy to inhaled corticosteroids/long-acting β-agonists, and in patients who do not tolerate long-acting bronchodilators or other medications, in the future.
噻托溴铵是一种长效毒蕈碱拮抗剂（LAMA），它通过阻断气道内源性乙酰胆碱受体发挥支气管扩张作用。其治疗慢性阻塞性肺疾病（COPD）的安全性和有效性已得到充分证实，目前它在改善哮喘患者肺功能和控制病情方面的作用也得到了认可。本综述讨论了Respimat吸入装置递送的噻托溴铵在不同严重程度和年龄段哮喘患者中的作用演变，并概述了安全性和有效性数据。噻托溴铵是目前唯一被批准用于治疗哮喘的LAMA，包括多项成人III期研究在内的大规模临床试验项目的证据表明，噻托溴铵可改善肺功能并控制哮喘，其安全性与安慰剂相当。针对青少年患者（12至17岁）的临床试验也显示肺功能有所改善，且有哮喘控制改善的趋势。值得注意的是，无论基线特征和表型如何，其疗效和安全性概况都是一致的。鉴于证据越来越多，随着对噻托溴铵临床经验的增加，这种治疗方法未来可能会成为吸入性糖皮质激素/长效β受体激动剂联合治疗的关键选择，以及不耐受长效支气管扩张剂或其他药物患者的关键选择。
