Effect of Daily Tiotropium on Allergen-Induced Early Asthmatic Responses and Airway Inflammation.

Long-acting muscarinic antagonists (LAMAs) have been approved as an add-on treatment for moderate-to-severe asthma—tiotropium as an individual inhaler and umeclidinium as a combination inhaler. Data from ovalbumin-sensitized and challenged animals treated with muscarinic antagonists, including tiotropium, reveal reductions in inflammatory markers and allergen-associated changes. 1 Ohta S Oda N Yokoe T Tanaka A Yamamoto Y Watanabe Y et al. Effect of tiotropium bromide on airway inflammation and remodelling in a mouse model of asthma. Clin Exp Allergy. 2010; 40: 1266-1275 Crossref PubMed Scopus (122) Google Scholar ,2 Kistemaker LEM Bos IST Menzen MH Maarsingh H Meurs H Gosens R. Combination therapy of tiotropium and ciclesonide attenuates airway inflammation and remodeling in a guinea pig model of chronic asthma. Respir Res. 2016; 17: 13 Crossref PubMed Scopus (37) Google Scholar Inhaled muscarinic antagonists may, therefore, protect the airways of patients with allergic asthma through both bronchodilators (ie, decrease the early asthmatic response [EAR]) and anti-inflammatory action (ie, decrease type 2 [T2] eosinophilic airway inflammation). Single-dose short-acting muscarinic antagonists (eg, ipratropium) partially inhibit allergen-induced EARs in human studies. 3 Cockcroft DW Ruffin RE Haargreave FE. Effect of Sch1000 in allergen-induced asthma. Clin Allergy. 1978; 8: 361-372 Crossref PubMed Scopus (35) Google Scholar ,4 Orehek J Gayrard P Ch Grimaud Charpin J. Allergen-induced bronchoconstriction in asthma: antagonistic effect of a synthetic anticholinergic drug (author's transl)]. Bull Physiopathol Respir (Nancy). 1975; 11: 193-201 PubMed Google Scholar There are no human data on LAMA efficacy against allergen-induced asthmatic responses. Here, we report the results of a pilot investigation of the efficacy of regular use of tiotropium on the allergen-induced EAR and T2 eosinophilic airway inflammation.