PMID- 25030457
OWN - NLM
STAT- MEDLINE
DCOM- 20150219
LR  - 20211021
IS  - 2055-1010 (Electronic)
IS  - 2055-1010 (Linking)
VI  - 24
DP  - 2014 Jul 17
TI  - Is there a rationale and role for long-acting anticholinergic bronchodilators in 
      asthma?
PG  - 14023
LID - 10.1038/npjpcrm.2014.23 [doi]
AB  - Despite current guidelines and the range of available treatments, over a half of 
      patients with asthma continue to suffer from poor symptomatic control and remain 
      at risk of future worsening. Although a number of non-pharmacological measures 
      are crucial for good clinical management of asthma, new therapeutic controller 
      medications will have a role in the future management of the disease. Several 
      long-acting anticholinergic bronchodilators are under investigation or are 
      available for the treatment of respiratory diseases, including tiotropium 
      bromide, aclidinium bromide, glycopyrronium bromide, glycopyrrolate and 
      umeclidinium bromide, although none is yet licensed for the treatment of asthma. 
      A recent Phase III investigation demonstrated that the once-daily long-acting 
      anticholinergic bronchodilator tiotropium bromide improves lung function and 
      reduces the risk of exacerbation in patients with symptomatic asthma, despite the 
      use of inhaled corticosteroids (ICS) and long-acting beta2-agonists (LABAs). This 
      has prompted the question of what the rationale is for long-acting 
      anticholinergic bronchodilators in asthma. Bronchial smooth muscle contraction is 
      the primary cause of reversible airway narrowing in asthma, and the baseline 
      level of contraction is predominantly set by the level of 'cholinergic tone'. 
      Patients with asthma have increased bronchial smooth muscle tone and mucus 
      hypersecretion, possibly as a result of elevated cholinergic activity, which 
      anticholinergic compounds are known to reduce. Further, anticholinergic compounds 
      may also have anti-inflammatory properties. Thus, evidence suggests that 
      long-acting anticholinergic bronchodilators might offer benefits for the 
      maintenance of asthma control, such as in patients failing to gain control on ICS 
      and a LABA, or those with frequent exacerbations.
FAU - Price, David
AU  - Price D
AD  - 1] Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK [2] 
      Research in Real Life Ltd, Cambridge, UK.
FAU - Fromer, Leonard
AU  - Fromer L
AD  - Department of Family Medicine, David Geffen School of Medicine at UCLA, Los 
      Angeles, CA, USA.
FAU - Kaplan, Alan
AU  - Kaplan A
AD  - Family Physician Airways Group of Canada, Richmond Hill, ON, Canada.
FAU - van der Molen, Thys
AU  - van der Molen T
AD  - Department of General Practice, University of Groningen, University Medical 
      Center, Groningen, The Netherlands.
FAU - Roman-Rodriguez, Miguel
AU  - Roman-Rodriguez M
AD  - Son Pisa Primary Health Care Centre, Balearic Health Service, Palma de Mallorca, 
      Spain.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20140717
PL  - England
TA  - NPJ Prim Care Respir Med
JT  - NPJ primary care respiratory medicine
JID - 101631999
RN  - 0 (Anti-Asthmatic Agents)
RN  - 0 (Bronchodilator Agents)
RN  - 0 (Cholinergic Antagonists)
RN  - 0 (Delayed-Action Preparations)
SB  - IM
MH  - Anti-Asthmatic Agents/administration & dosage/*therapeutic use
MH  - Asthma/*drug therapy/physiopathology
MH  - Bronchodilator Agents/administration & dosage/*therapeutic use
MH  - Cholinergic Antagonists/administration & dosage/*therapeutic use
MH  - Delayed-Action Preparations
MH  - Humans
PMC - PMC4373380
EDAT- 2014/07/18 06:00
MHDA- 2015/02/20 06:00
PMCR- 2014/07/17
CRDT- 2014/07/18 06:00
PHST- 2013/07/19 00:00 [received]
PHST- 2014/02/14 00:00 [revised]
PHST- 2014/03/28 00:00 [accepted]
PHST- 2014/07/18 06:00 [entrez]
PHST- 2014/07/18 06:00 [pubmed]
PHST- 2015/02/20 06:00 [medline]
PHST- 2014/07/17 00:00 [pmc-release]
AID - npjpcrm201423 [pii]
AID - 10.1038/npjpcrm.2014.23 [doi]
PST - epublish
SO  - NPJ Prim Care Respir Med. 2014 Jul 17;24:14023. doi: 10.1038/npjpcrm.2014.23.