Chari V Madhu, McIvor Robert Andrew
McMaster University, Firestone Institute for Respiratory Health, Hamilton, ON, Canada.
Can Respir J. 2018 Jan 21;2018:3464960. doi: 10.1155/2018/3464960. eCollection 2018.
Asthma is a chronic disease of airway inflammation with a large global burden. Despite established, guideline-based stepwise therapy, a significant proportion of patients remain symptomatic and poorly controlled. As such, there is a need for additional safe, effective, convenient, and cost-effective therapies that can be broadly applied across a range of asthma phenotypes. Tiotropium is a long-acting muscarinic antagonist (LAMA) that leads to bronchodilation by blocking endogenous acetylcholine receptors in the airways. Tiotropium has long been approved for the treatment of chronic obstructive pulmonary disease, and it has recently been recognized for its safety and efficacy in improving lung function and controlling asthma. Evidence from several Phase III trials in the adult and paediatric population has shown that tiotropium is well tolerated and significantly improves a range of endpoints as an add-on treatment to ICS therapy, regardless of baseline characteristics and clinical phenotypes. Consequently, regulatory authorities worldwide have recently licensed tiotropium as the only LAMA approved for the treatment of asthma. This review provides an overview of safety and efficacy data and discusses the use of tiotropium in patients across the range of asthma severities, ages, and phenotypes.
哮喘是一种气道炎症性慢性病，全球负担沉重。尽管有既定的、基于指南的逐步治疗方法，但仍有相当一部分患者有症状且控制不佳。因此，需要额外的安全、有效、方便且具有成本效益的疗法，这些疗法可广泛应用于一系列哮喘表型。噻托溴铵是一种长效毒蕈碱拮抗剂（LAMA），通过阻断气道中的内源性乙酰胆碱受体导致支气管扩张。噻托溴铵长期以来被批准用于治疗慢性阻塞性肺疾病，最近因其在改善肺功能和控制哮喘方面的安全性和有效性而受到认可。来自成人和儿童人群的多项III期试验的证据表明，作为ICS治疗的附加治疗，噻托溴铵耐受性良好，显著改善了一系列终点指标，无论基线特征和临床表型如何。因此，全球监管机构最近已批准噻托溴铵作为唯一被批准用于治疗哮喘的LAMA。本综述概述了安全性和有效性数据，并讨论了噻托溴铵在不同严重程度、年龄和表型的哮喘患者中的应用。
