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The Bronchodilator and Anti‐Inflammatory Effect of Long‐Acting Muscarinic Antagonists in Asthma: An EAACI Position Paper

An EAACI Position Paper
Authors: Agache, Ioana; Adcock, Ian; Akdis, Cezmi; Akdis, Mübeccel; Bentabol-Ramos, Guillermo; van den Berge, Maarten; Boccabella, Cristina; +26 Authors

The Bronchodilator and Anti‐Inflammatory Effect of Long‐Acting Muscarinic Antagonists in Asthma: An EAACI Position Paper

Abstract

ABSTRACTAs cholinergic innervation is a major contributor to increased vagal tone and mucus secretion, inhaled long‐acting muscarinic antagonists (LAMA) are a pillar for the treatment of chronic obstructive pulmonary disease and asthma. By blocking the muscarinic receptors expressed in the lung, LAMA improve lung function and reduce exacerbations in asthma patients who remained poorly controlled despite treatment with inhaled corticosteroids and long‐acting β2 agonists. Asthma guidelines recommend LAMA as a third controller to be added on before the initiation of biologicals. In addition to bronchodilation, LAMA also exert anti‐inflammatory and anti‐fibrotic effects by inhibiting muscarinic receptors present in neutrophils, macrophages, fibroblasts and airway smooth muscle cells. Thus, besides bronchodilation, LAMA might provide additional therapeutic effects, thereby supporting an endotype‐driven approach to asthma management. The Position Paper, developed by the Asthma Section of the European Academy of Allergy and Clinical Immunology, discusses the main cholinergic pathways in the lung, reviews the findings of significant clinical trials and real‐life studies on LAMA use in asthma, examines the placement of these drugs in asthma clinical guidelines, and considers the potential for personalised medicine with LAMA in both adult and paediatric asthma patients.

Countries
France, France, Poland, France, Greece, Italy, Netherlands, Portugal, United Kingdom, Spain
Keywords

Time Factors, bronchodilator, precision medicine, 3205.08 Enfermedades Pulmonares, Anti-Inflammatory Agents, Muscarinic Antagonists, broncodilatadores, 3207.01 Alergias, 3208.08 Mecanismos de Acción de Los Medicamentos, Endotype, Pulmonary Disease, Chronic Obstructive, long-acting muscarinic antagonists, acetilcolina, Muscarine, Animals, Humans, Anti-Asthmatic Agents, endotype, Societies, Medical, antiviral therapy; community‐acquired respiratory viral infection; hematological malignancy; secondary infection; vaccine coverage, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, Precision medicine, asthma, acetylcholine, Acetylcholine, Asthma, Bronchodilator Agents, Long-acting muscarinic antagonist, asma, acetylcholine; asthma; bronchodilator; endotype; long-acting muscarinic antagonists; precision medicine, Bronchodilator, antiasmáticos, antagonistas muscarínicos

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    selected citations
    These citations are derived from selected sources.
    This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
    18
    popularity
    This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
    Top 10%
    influence
    This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
    Top 10%
    impulse
    This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
    Top 10%
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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
18
Top 10%
Top 10%
Top 10%
Green
hybrid