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.

中文翻译：

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长效毒蕈碱拮抗剂在哮喘中的支气管扩张剂和抗炎作用：EAACI 立场文件


由于胆碱能神经支配是迷走神经张力和粘液分泌增加的主要因素，因此吸入长效毒蕈碱拮抗剂 （LAMA） 是治疗慢性阻塞性肺病和哮喘的支柱。通过阻断肺中表达的毒蕈碱受体，LAMA 改善了肺功能并减少哮喘患者的恶化，这些患者尽管接受了吸入皮质类固醇和长效 β2 激动剂治疗，但控制仍然不佳。哮喘指南建议将 LAMA 作为在开始使用生物制剂之前添加的第三个控制器。除了支气管扩张外，LAMA 还通过抑制存在于中性粒细胞、巨噬细胞、成纤维细胞和气道平滑肌细胞中的毒蕈碱受体来发挥抗炎和抗纤维化作用。因此，除了支气管扩张外，LAMA 还可能提供额外的治疗效果，从而支持内型驱动的哮喘管理方法。由欧洲过敏和临床免疫学学会哮喘科制定的立场文件讨论了肺部的主要胆碱能途径，回顾了 LAMA 在哮喘中使用的重要临床试验和真实研究的结果，检查了这些药物在哮喘临床指南中的位置，并考虑了成人和儿童哮喘患者使用 LAMA 进行个性化治疗的潜力。