Division of Allergy and Immunology, University of South Florida, Tampa, Fla.
Advocate Health Care, Chicago, Ill.
J Allergy Clin Immunol. 2022 Sep;150(3):557-568. doi: 10.1016/j.jaci.2022.06.015. Epub 2022 Aug 3.
Patients with asthma who are suboptimally responsive to inhaled corticosteroids (ICS) and long-acting β-agonists (LABAs) are frequently exposed to oral corticosteroids and high-dose ICS, which can lead to significant side effects. Long-acting muscarinic antagonists (LAMAs) have demonstrated efficacy and safety in a subset of these patients. This review summarizes the results of key studies using LAMAs in patients with asthma aged 12 years or older. LAMA as an add-on treatment improved lung function and asthma control in patients with uncontrolled asthma across studies. The efficacy of LAMAs as an add-on to ICS was superior to that of placebo and ICS dose escalation and comparable with that of LABAs. LAMA plus ICS plus LABA provided modest improvements in bronchodilation and increased the time to first severe exacerbation versus ICS plus LABA. Single-inhaler triple therapy was associated with decreased health care resource utilization and improved cost-effectiveness versus multiple inhalers. LAMAs were generally well tolerated; asthma exacerbations, bronchitis, and nasopharyngitis were common adverse events with LAMA in combination with ICS alone or ICS plus LABA. Thus, the overall evidence presented in this review supports the use of add-on LAMA treatment as a reasonable option in patients with asthma uncontrolled with ICS plus LABA or ICS alone.
哮喘患者对吸入性皮质类固醇（ICS）和长效β-激动剂（LABAs）的反应不理想时，经常会使用口服皮质类固醇和高剂量 ICS，这可能会导致严重的副作用。长效抗胆碱能拮抗剂（LAMA）在这些患者中的一部分中已被证明具有疗效和安全性。这篇综述总结了在 12 岁或以上哮喘患者中使用 LAMA 的关键研究结果。在研究中，LAMA 作为附加治疗可改善未控制哮喘患者的肺功能和哮喘控制。与安慰剂和 ICS 剂量增加相比，LAMA 作为 ICS 的附加治疗可提高疗效，与 LABA 相当。LAMA 联合 ICS 和 LABA 与 ICS 联合 LABA 相比，在支气管扩张方面略有改善，并首次增加严重恶化的时间。与多个吸入器相比，单吸入器三联疗法可减少医疗资源的利用并提高成本效益。LAMA 通常具有良好的耐受性；与单独使用 ICS 或 ICS 加 LABA 联合使用时，哮喘恶化、支气管炎和鼻咽炎是常见的不良反应。因此，本综述中提出的总体证据支持在 ICS 加 LABA 或 ICS 单独治疗无法控制的哮喘患者中，使用附加 LAMA 治疗作为合理选择。
