The Bronchodilator and Anti‐Inflammatory Effect of Long‐Acting Muscarinic Antagonists in Asthma: An EAACI Position Paper

Abstract

As cholinergic innervation is a major contributor to increased vagal tone and mucus secretion, inhaled long-acting muscarinic antagonists (LAMA) are a pillar for the treatment of chronic obstructive pulmonary disease and asthma. By blocking the muscarinic receptors expressed in the lung, LAMA improve lung function and reduce exacerbations in asthma patients who remained poorly controlled despite treatment with inhaled corticosteroids and long-acting β2 agonists. Asthma guidelines recommend LAMA as a third controller to be added on before the initiation of biologicals. In addition to bronchodilation, LAMA also exert anti-inflammatory and anti-fibrotic effects by inhibiting muscarinic receptors present in neutrophils, macrophages, fibroblasts and airway smooth muscle cells. Thus, besides bronchodilation, LAMA might provide additional therapeutic effects, thereby supporting an endotype-driven approach to asthma management. The Position Paper, developed by the Asthma Section of the European Academy of Allergy and Clinical Immunology, discusses the main cholinergic pathways in the lung, reviews the findings of significant clinical trials and real-life studies on LAMA use in asthma, examines the placement of these drugs in asthma clinical guidelines, and considers the potential for personalised medicine with LAMA in both adult and paediatric asthma patients.

Metadata

Item Type:	Article
Authors/Creators:	Agache, I. https://orcid.org/0000-0001-7994-364X Adcock, I.M. https://orcid.org/0000-0003-2101-8843 Akdis, C.A. https://orcid.org/0000-0001-8020-019X Akdis, M. Bentabol‐Ramos, G. van den Berge, M. Boccabella, C. https://orcid.org/0000-0003-1942-8886 Canonica, W.G. Caruso, C. https://orcid.org/0000-0001-7631-029X Couto, M. https://orcid.org/0000-0003-4987-9346 Davila, I. Drummond, D. Fonseca, J. Gherasim, A. https://orcid.org/0000-0002-3198-1396 del Giacco, S. Jackson, D.J. https://orcid.org/0000-0002-2299-868X Jutel, M. https://orcid.org/0000-0003-1555-9379 Licari, A. Loukides, S. https://orcid.org/0000-0002-4278-9922 Moreira, A. Mukherjee, M. https://orcid.org/0000-0002-7924-7211 Ojanguren, I. Palomares, O. https://orcid.org/0000-0003-4516-0369 Papi, A. https://orcid.org/0000-0002-6924-4500 Perez de Llano, L. https://orcid.org/0000-0003-2652-6847 Price, O.J. https://orcid.org/0000-0001-8596-4949 Rukhazde, M. Shamji, M.H. https://orcid.org/0000-0003-3425-3463 Shaw, D. https://orcid.org/0000-0003-4106-8469 Sanchez‐Garcia, S. Testera‐Montes, A. Torres, M.J. https://orcid.org/0000-0001-5228-471X Eguiluz‐Gracia, I. https://orcid.org/0000-0002-3774-931X
Copyright, Publisher and Additional Information:	© 2024 European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd. This is the peer reviewed version of the following article: Agache, I. , Adcock, I.M. , Akdis, C.A. et al. (30 more authors) (2024) The Bronchodilator and Anti‐Inflammatory Effect of Long‐Acting Muscarinic Antagonists in Asthma: An EAACI Position Paper. Allergy. ISSN 0105-4538, which has been published in final form at https://doi.org/10.1111/all.16436. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. This article may not be enhanced, enriched or otherwise transformed into a derivative work, without express permission from Wiley or by statutory rights under applicable legislation. Copyright notices must not be removed, obscured or modified. The article must be linked to Wiley’s version of record on Wiley Online Library and any embedding, framing or otherwise making available the article or pages thereof by third parties from platforms, services and websites other than Wiley Online Library must be prohibited.
Keywords:	acetylcholine; asthma; bronchodilator; endotype; long-acting muscarinic antagonists; precision medicine
Dates:	Accepted: 4 December 2024 Published (online): 16 December 2024 Published: February 2025
Institution:	The University of Leeds
Academic Units:	The University of Leeds > Faculty of Biological Sciences (Leeds) > School of Biomedical Sciences (Leeds)
Depositing User:	Symplectic Publications
Date Deposited:	18 Dec 2024 16:14
Last Modified:	16 Apr 2025 10:35
Status:	Published
Publisher:	Wiley
Identification Number:	10.1111/all.16436
Open Archives Initiative ID (OAI ID):	oai:eprints.whiterose.ac.uk:220919

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The Bronchodilator and Anti‐Inflammatory Effect of Long‐Acting Muscarinic Antagonists in Asthma: An EAACI Position Paper

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