Don’t dismiss anticholinergics
A: The jury is still out.
Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy
Despite fears about long acting beta-agonists (LABAs), the Blacks and Exacerbations on LABA vs. Tiotropium (BELT) trial results do not support the superiority of LABA + ICS compared to tiotropium + ICS for black asthma patients.
Increasing evidence supports the therapeutic use of anticholinergic agents for asthma, particularly for patients with airway obstruction or signs of higher cholinergic tone. These study findings do not provide enough evidence to overturn the National Asthma Education and Prevention Program’s (NAEPP) Third Expert Panel Report guidelines for prescribing ICS + LABA for this patient population.
There is a black box warning on LABAs, but there are no obvious treatment benefits to LABA vs. anti-cholinergics in this study. Currently anticholinergic agents are not included in the step approach to the NAEPP’s asthma treatment protocols. However, this study lends more support that anticholinergics may be a considered as an additional therapeutic option for treating asthma.
How this study will impact the treatment of black patients with asthma is unclear since there was no superiority of LABA + ICS vs. tiotropium + ICS in primary or secondary outcomes. Further studies, including placebo-controlled studies and improved objective testing of severity of asthma when including patients in the study, are needed.
Sandra Hong, MD
Sandra Hong, MD, in the Cleveland Clinic Department of Pulmonary, Allergy and Critical Care Medicine, can be reached at 440.878.2500 or hongs3@ccf.org.
David M. Lang, MD
David M. Lang, MD, Chair of the Department of Allergy and Clinical Immunology, can be reached at 216.445.5810 or langd@ccf.org.
A review of IDSA and NIH guidelines
Caregivers are provided with real-time bronchoscopy patient findings
New program sets out to better support underserved patient populations
As the U.S. has seen an increase in respiratory-related morbidity and mortality, supporting future respiratory researchers has become imperative
Diagnosing the cause of a chronic cough can be challenging and timely, but multidisciplinary collaboration and the development of new treatments are improving the process
Despite a decline in numbers, the demand for respiratory therapists continues to rise
A mindset shift has changed the way pulmonologists both treat and define PFF
Will enable patients with long COVID to enroll in national clinical trials