title: Role of muscarinic antagonists in asthma therapy.
abstract: Higher parasympathetic tone has been reported in asthmatics. In general, cholinergic contractile tone is increased by airway inflammation associated with asthma. Nevertheless, the role of muscarinic antagonists for the treatment of asthma has not yet been clearly defined. Areas covered: The use of SAMAs and LAMAs in asthma has been examined and discussed according with the published evidence. Particular attention has been given to the large Phase III clinical trial program designed to evaluate the efficacy and safety of tiotropium respimat added to standard treatment in adults, adolescents and children with persistent asthma across the spectrum of asthma severity. Expert commentary: The current evidence is that in patients with poorly controlled severe asthma despite the use of ICS and LABA, the addition of tiotropium significantly increases the time to the first severe exacerbation and provides a modest but sustained bronchodilation. Identical results should be produced using other LAMAs. In any case, the documentation that, at least in animal or in vitro models, LAMAs show significant anti-inflammatory and anti-proliferative capacities and are able to inhibit airway remodeling induced by allergens makes a strong presumption that the use of LAMAs in asthma may go beyond the simple bronchodilator effect.
authors.affiliation: a Chair of Respiratory Medicine, Department of Systems Medicine , University of Rome Tor Vergata , Rome , Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Cazzola
authors.affiliation: b Division of Respiratory Medicine, Department of Internal Medicine , University Hospital Tor Vergata , Rome , Italy.
authors.forename: Josuel
authors.initials: J
authors.lastname: Ora
authors.affiliation: a Chair of Respiratory Medicine, Department of Systems Medicine , University of Rome Tor Vergata , Rome , Italy.|b Division of Respiratory Medicine, Department of Internal Medicine , University Hospital Tor Vergata , Rome , Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Rogliani
authors.affiliation: c Chair of Pharmacology, Department of Experimental Medicine , Second University of Naples , Naples , Italy.
authors.forename: Maria Gabriella
authors.initials: MG
authors.lastname: Matera
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D056151:Airway Remodeling; D001249:Asthma / Q000188:drug therapy*; D001993:Bronchodilator Agents / Q000627:therapeutic use; D017326:Clinical Trials, Phase III as Topic; D004359:Drug Therapy, Combination; D006801:Humans; D018727:Muscarinic Antagonists / Q000627:therapeutic use*; D000069447:Tiotropium Bromide / Q000627:therapeutic use
chemical_list: D000305:Adrenal Cortex Hormones; D001993:Bronchodilator Agents; D018727:Muscarinic Antagonists; D000069447:Tiotropium Bromide
keywords: Adults; asthma; children; glycopyrronium; long acting muscarinic antagonists; parasympathetic tone; short acting muscarinic antagonists; tiotropium; umeclidinium