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, NICE, SIGN and GINA recommend LAMA as an option for adult patients with severe asthma who are not controlled with moderate-dose maintenance and reliever therapy (MART) ICS+LABA regimens.2,3
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.4
LABA stimulate bronchodilation
acting via the adrenergic pathway.4
LAMA reduce bronchoconstriction
working via the cholinergic pathway.1
Consider adding a LAMA such as SPIRIVA Respimat as part of a combined treatment regimen for your patients with uncontrolled severe asthma despite good adherence2,5
Prescribing SPIRIVA Respimat as an add-on therapy in a separate inhaler allows patients to continue with their moderate dose ICS+LABA regimen.2,5
Refer patient to a specialist if asthma is not controlled within 12 weeks despite treatment with moderate-dose ICS+LABA regimen and a LAMA5
Abbreviations
BTS, British Thoracic Society; GINA, Global Initiative for Asthma; ICS, inhaled corticosteroid; LABA, long-acting β2-agonist; LAMA, long-acting muscarinic antagonist; NICE, National Institute for Health and Care Excellence.
References
- SPIRIVA Respimat (tiotropium) 2.5 μg Summary of Product Characteristics.
- Global Initiative for Asthma (GINA). Global Strategy for Asthma Management and Prevention. Available at: https://ginasthma.org/2024-report/ (accessed February 2025).
- BTS, NICE, SIGN. Asthma: diagnosis, monitoring and chronic asthma management. 2024. Available at: https://www.nice.org.uk/guidance/ng244 (accessed February 2025).
- Barnes PJ. Pharmaceuticals 2010;3(3):514–540.
- AWMSG. All Wales Adult Asthma Management and Prescribing Guideline, 2024. Available at: https://awttc.nhs.wales/medicines-optimisation-and-safety/medicines-optimisation-guidance-resources-and-data/prescribing-guidance/all-wales-adult-asthma-management-and-prescribing-guideline/ (accessed February 2025).
PC-GB-109487 V1 February 2025