Asthma Guidelines Priority Topic: Long-Acting Anti-Muscarinic Agents in Asthma Management as Add-On to Inhaled Corticosteroids

The National Asthma Education and Prevention Program Guidelines for the Diagnosis and Management of Asthma are slated to be updated on 6 topic areas. This review summarizes the findings for the charge to assess efficacy of adding long-acting muscarinic antagonist (LAMA) to inhaled corticosteroids (ICSs) with or without long-acting beta-agonist (LABA) in patients 12 years with uncontrolled, persistent asthma. The complete report can be found on the Agency for Healthcare Research and Quality website. LAMA compared with placebo effectively reduces the risk of asthma exacerbations. When comparing add-on therapy with LABA, both classes of drugs have similar effects on clinical outcomes. The addition of LAMA to dual therapy (ICS+additional controller) provides no substantial added benefit compared with dual therapy. The efficacy of LAMA in children and adolescents is less convincing for exacerbation and asthma worsening outcomes, but provides improvement in forced expiratory volume in the first second compared with placebo.