Tiotropium in asthma: From bench to bedside

Abstract

Tiotropium is a long-acting muscarinic antagonist approved for maintenance treatment of asthma in children, adolescents, and adults in the United States, and recommended as add-on treatment for uncontrolled asthma despite treatment with inhaled corticosteroids and/or long-acting beta-2 agonists. This review traces the journey of tiotropium from its historical origins through early preclinical testing to human clinical trials and real-life studies. Data sources: A search was performed in PubMed using search terms 'tiotropium' and 'asthma.' Relevant references cited in those articles were reviewed. Study selections: English language articles published from December 2008-December 2018 were screened. Articles evaluating the efficacy, cost-effectiveness, real-life evidence, and steroid-sparing effect of tiotropium with inadequately controlled asthma were included. Results: Anticholinergics have a long history of use in the treatment of obstructive airway diseases. Evidence indicates that tiotropium's mechanism of action consists of bronchodilation and diminished mucus secretion, with preclinical evidence suggesting an anti-inflammatory effect as well. Phase 2 and 3 clinical trials have demonstrated that tiotropium is efficacious and safe, resulting in significant improvements in lung function in adults, adolescents, and children across asthma severities. Emerging evidence suggests that add-on tiotropium might potentially enable reductions in inhaled corticosteroid dose in patients with uncontrolled asthma. Further, tiotropium is a cost-effective treatment option that is also effective in the clinical practice setting. Conclusions: An increasing body of evidence indicates that tiotropium can play a significant role in the treatment of patients with uncontrolled asthma.

Inhaled long-acting muscarinic antagonists in asthma – A narrative review

“…The efficacy of muscarinic antagonists in asthma has been known since the early 1800s when inhalation of smoke from burning Datura stramonium leaves and roots became widespread in Britain as a treatment for obstructive airway disease (reviewed by Mansfield and Bernstein [1]). Once identified as the active agent, subsequent clinical studies were conducted with atropine [2], in turn replaced by the short-acting muscarinic antagonist (SAMA) ipratropium bromide due to better efficacy and lower systemic effects [3].…”

Bis-Quinolinium Cyclophane Blockers of SK Potassium Channels Are Antagonists of M3 Muscarinic Acetylcholine Receptors

“…Poorly absorbed quaternary ammonium-inhaled muscarinic antagonists such as ipatroprium (short acting), and tiotropium (long acting) have long been used as inhaled bronchodilators for chronic obstructive pulmonary disease ( Ariel et al., 2018 ; Yamada and Ichinose, 2018 ), and more recently as an adjunct therapy for asthma ( Mansfield and Bernstein, 2019 ). Given that UCL 1684 is also a muscarinic receptor antagonist, we examined its effects on airway contractions.…”

Plantas medicinales usadas comúnmente en México: lo bueno y lo malo

“…El Reminyl®, se fabrica con la galantamina aislada de Eucojum aestivum (nombre común campanilla de primavera), y se utiliza para tratar la enfermedad de Alzheimer (Lopez, 2011). El Spiriva® se produce a partir del compuesto tiotropio, que está en Atropa belladonna L. (nombre común belladona) (Lopez, 2011;Mansfield & Bernstein, 2019). El Coartem®, que se utiliza para tratar la enfermedad de la malaria, contiene dos derivados de la artemisinina (Arteméter y lumefantrina), que proviene de Artemisia annua L. (nombre común ajenjo) (Premji, 2009).…”