Long-acting Muscarinic Antagonists and Their Role in Children with Recurrent Wheezing or Asthma: An Updated Review

Abstract

Long-acting muscarinic antagonists (LAMAs) are a class of bronchodilators that work by blocking the muscarinic receptors in the airway smooth muscle, leading to bronchodilation and reduced mucus secretion. They are primarily used in the management of chronic obstructive pulmonary disease, but their use in asthma, including in pediatric patients, has been increasing, especially in cases where asthma is not well-controlled by standard therapies. The Global Initiative for Asthma includes LAMAs as add-on therapy for children with severe asthma who are not adequately controlled with inhaled corticosteroid and long-acting beta-agonists. They are not recommended as a first-line treatment for children with mild asthma. The most commonly used LAMA in children with asthma is tiotropium, which has been studied for its efficacy and safety in this population. In this updated review, we have discussed the pharmacology, efficacy, and safety of LAMAs in children with recurrent wheezing and asthma.