How would you treat a severe asthma patient?

SPIRIVA® Respimat® (tiotropium) is indicated as add-on maintenance bronchodilator treatment in patients aged 6 years and older with severe asthma who experienced one or more severe asthma exacerbations in the preceding year. In adult patients with severe asthma, tiotropium should be used in addition to inhaled corticosteroids (≥ 800μg budesonide/day or equivalent) and at least one controller.1

How can LAMA (tiotropium) help your patients with severe asthma?

SPIRIVA® Respimat® (tiotropium) is an inhalation solution containing tiotropium, a long-acting muscarinic receptor antagonist (LAMA), which is delivered via the Respimat® inhaler device.1 Tiotropium bromide is a long acting, specific antagonist at muscarinic receptors.1 In the airways, tiotropium bromide competitively and reversibly binds to the M3 receptors in the bronchial smooth muscle, antagonising the cholinergic (bronchoconstrictive) effects of acetylcholine, resulting in bronchial smooth muscle relaxation.1

BTS/SIGN, National Institute for Health and Care Excellence (NICE) and Global Initiative for Asthma (GINA) recommend LAMA as an option for adult patients with severe asthma who are not well controlled with maintenance or maintenance and reliever therapy (MART) ICS/LABA regimens.2–4

As a LAMA, tiotropium has a distinct mechanism of action compared to ICS and LABA:

ICS regulate inflammation

reducing the numbers of inflammatory cells in the airways.5

LABA stimulate bronchodilation

acting via the adrenergic pathway.5

LAMA reduce bronchoconstriction

working via the cholinergic pathway.1

When considering LAMA as an add-on therapy for severe asthma patients, it can be prescribed in a single inhaler or in a combination (‘triple’) inhaler.2,6 ‘Triple therapy’ inhalers contain different strengths of ICS and caution is needed to ensure that the required dose of ICS is not inadvertently stepped up or down when commencing a ‘triple therapy’ inhaler.6 Prescribing LAMA as an add-on therapy in a separate inhaler may provide more flexibility when escalating or de-escalating treatments compared to a ‘triple’ inhaler.

GINA recommend an add-on LAMA as an option for patients ≥6 years with severe asthma who are not adequately controlled by ICS/LABA regimens.2

Abbreviations

  • BTS/SIGN, British Thoracic Society/Scottish Intercollegiate Guidelines Network; GINA, Global Initiative for Asthma; ICS, inhaled corticosteroid; LABA, long-acting β2-agonist; LAMA, long-acting muscarinic antagonist; NICE, National Institute for Heath and Care Excellence.
References
  1. SPIRIVA® Respimat® (tiotropium) 2.5 μg Summary of Product Characteristics.
  2. Global Initiative for Asthma (GINA). Global Strategy for Asthma Management and Prevention. Available at: https://ginasthma.org/wp-content/uploads/2022/07/GINA-Main-Report-2022-FINAL-22-07-01-WMS.pdf (accessed March 2023).
  3. BTS/SIGN. British guideline on the management of asthma, 2019. Available at: www.brit-thoracic.org.uk/quality-improvement/guidelines/asthma/ (accessed March 2023).
  4. NICE guideline [NG80]. Asthma: diagnosis, monitoring and chronic asthma management, 2021. Available at: www.nice.org.uk/guidance/ng80 (accessed March 2023).
  5. Barnes PJ. Pharmaceuticals 2010;3(3):514–540.
  6. AWMSG. All Wales Adult Asthma Management and Prescribing Guideline, 2021. Available at: https://awttc.nhs.wales/files/guidelines-and-pils/all-wales-adult-asthma-management-and-prescribing-guideline-pdf/ (accessed March 2023).

PC-GB-107375 V1

March 2023

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