Muscarinic Antagonists; Delayed-Action Preparations; Anti-Asthmatic Agents; Humans; Asthma/drug therapy/epidemiology/diagnosis; Muscarinic Antagonists/administration & dosage; Male; Severity of Illness Index; Female; Europe/epidemiology; Administration, Inhalation; Middle Aged; Adult; Anti-Asthmatic Agents/administration & dosage; Practice Patterns, Physicians'; Surveys and Questionnaires; Asthma care; Bronchodilators; Clinical guidelines; Controller medication; Geographical variability; Real-world evidence; Severe asthma; Survey-based research
Abstract :
[en] BACKGROUND: There is limited real-world evidence on the use and positioning of inhaled long-acting muscarinic antagonists (LAMAs) for treating severe asthma. OBJECTIVE: We aimed to assess the differences in clinicians' perspectives on prescribing LAMA for severe asthma across Europe. METHODS: Within the Severe Heterogeneous Asthma Research collaboration, Patient-centred (SHARP) network, we conducted a multi-country survey of 470 respiratory clinicians in 2023-24. RESULTS: Most participants were pneumonologists (83%). 68% reported using specific criteria for prescribing LAMA for severe asthma, primarily fixed bronchial obstruction (68%), frequent asthma exacerbations (65%), and a history of smoking (53%). Improved quality of life, lung function improvement, and reduction of asthma exacerbations were the three expected outcomes of LAMA treatment that showed the largest agreement across clinicians (85-95%). As compared to non-severe asthma specialists (about 50% of the sample), severe asthma specialists were more likely to report always prescribing LAMA before biologics (54 vs. 41%) and before oral corticosteroids (OCS) (51 vs. 40%). Approximately 90% of participants prioritised tapering or discontinuing OCS before stopping LAMA. Overall, participants in Northern (n = 73) and Western Europe (n = 71) appeared less prone to prescribe LAMA and less confident in their benefits compared to those from Eastern (n = 88) and Southern Europe (n = 238). In particular, most participants from Latvia (91%) and Lithuania (67%) reported that LAMAs are not reimbursed for severe asthma in their countries. Most participants who expressed their opinion favoured triple therapy (n = 236) over single inhaler therapy (n = 91). CONCLUSION: Our findings show that barriers and heterogeneous approaches still limit LAMA prescription for severe asthma in Europe, potentially leading to the underuse of this treatment option. Establishing a clear role for LAMA within a precision medicine framework is crucial; this aspect is not yet firmly supported by current international recommendations.
Disciplines :
Cardiovascular & respiratory systems
Author, co-author :
Marcon, Alessandro; Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy. alessandro.marcon@univr.it.
Martinelli, Luigi; Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy.
Bansal, Aruna T; Acclarogen, Cambridge, UK.
Berret, Emmanuelle; European Respiratory Society, Lausanne, Switzerland.
Bossios, Apostolos; Karolinska Severe Asthma Center, Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Huddinge, Sweden. ; Division for Lung and Airway Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden. ; Lung Laboratory, Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden.
Marchetti, Pierpaolo; Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy.
Porsbjerg, Celeste; Department of Respiratory Medicine, Copenhagen University Hospital - Bispebjerg, Copenhagen, Denmark.
Principe, Stefania; Department of Respiratory Medicine, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
Schleich, Florence ; Université de Liège - ULiège > Département des Sciences de l'activité physique et de la réadaptation > Physiologie humaine et physiologie de l'effort physique
Sergejeva, Svetlana; The North Estonia Medical Centre, Tallinn, Estonia.
Sont, Jacob K; Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Netherlands.
Caminati, Marco; Allergy Unit and Asthma Center, Department of Medicine, Integrated University Hospital of Verona, University of Verona, Verona, Italy.
Language :
English
Title :
Use of long-acting muscarinic antagonists for severe asthma: insights from clinicians in the SHARP network.
E. Ridolo M. Milanese A. Barone F. Nicoletta M. Ottoni F.F. Cosini G. Passalacqua C. Lombardi Extrafine formulation of beclomethasone dipropionate/formoterol fumarate/glycopyrronium bromide delivered via pressurized metered-dose inhaler in the treatment of asthma: a review Ther Adv Respir Dis 19 10.1177/17534666251332076 40219730 12033506 17534666251332076
E. Hamelmann Managing severe asthma: a role for the long-acting muscarinic antagonist Tiotropium BioMed Res Int 10.1155/2018/7473690 30474042 6220412
K.M. Kew K. Dahri Long-acting muscarinic antagonists (LAMA) added to combination long-acting beta2 -agonists and inhaled corticosteroids (LABA/ICS) versus LABA/ICS for adults with asthma Cochrane Database Syst Reviews 10.1002/14651858.CD011721.pub2
A. Papi L.M. Fabbri H.A.M. Kerstjens P. Rogliani H. Watz D. Singh Inhaled long-acting muscarinic antagonists in asthma – a narrative review Eur J Intern Med 85 14 22 10.1016/j.ejim.2021.01.027 33563506
H.K. Reddel L.B. Bacharier E.D. Bateman C.E. Brightling G.G. Brusselle R. Buhl A.A. Cruz L. Duijts J.M. Drazen J.M. FitzGerald L.J. Fleming H. Inoue F.W. Ko J.A. Krishnan M.L. Levy J. Lin K. Mortimer P.M. Pitrez A. Sheikh A.A. Yorgancioglu L.-P. Boulet Global initiative for asthma strategy 2021: executive summary and rationale for key changes Am J Respir Crit Care Med 205 17 35 10.1164/rccm.202109-2205PP 34658302
F. Puggioni L. Brussino G.W. Canonica F. Blasi P. Paggiaro M. Caminati M. Latorre E. Heffler G. Senna Frequency of Tiotropium bromide use and clinical features of patients with severe asthma in a real-life setting: data from the severe asthma network in Italy (SANI) registry J Asthma Allergy 13 599 604 10.2147/JAA.S274245 33204116 7667506
R. Djukanovic I.M. Adcock G. Anderson E.H. Bel G.W. Canonica H. Cao K.F. Chung D.E. Davies C. Genton T. Gibson-Latimer D. Hamerlijnck E. Heuvelin R. Louis S. Korn M. Kots N. Kwon R. Naddaf S.S. Wagers The severe heterogeneous asthma research collaboration, Patient-centred (SHARP) ERS clinical research collaboration The severe heterogeneous asthma research collaboration, patient-centred (SHARP) ERS clinical research collaboration: a new dawn in asthma research Eur Respir J 52 10.1183/13993003.01671-2018 30498052 1801671
G. Heinze M. Schemper A solution to the problem of separation in logistic regression Stat Med 21 2409 19 10.1002/sim.1047 12210625
M.M. Cloutier A.E. Dixon J.A. Krishnan R.F. Lemanske W. Pace M. Schatz Managing asthma in adolescents and adults: 2020 asthma guideline update from the National Asthma Education and Prevention Program JAMA 324 2301 17 10.1001/jama.2020.21974 33270095
S. Khurana A. Bush F. Holguin Management of severe asthma: summary of the European respiratory society/American thoracic society task force report Breathe 10.1183/20734735.0058-2020 33304407 7714544
J.C. Virchow P. Kuna P. Paggiaro A. Papi D. Singh S. Corre F. Zuccaro A. Vele M. Kots G. Georges S. Petruzzelli G.W. Canonica Single inhaler extrafine triple therapy in uncontrolled asthma (TRIMARAN and TRIGGER): two double-blind, parallel-group, randomised, controlled phase 3 trials Lancet 394 1737 49 10.1016/S0140-6736(19)32215-9 31582314
A.-N. Frix L.G. Heaney B. Dahlén F. Mihaltan S. Sergejeva S. Popović-Grle V. Sedlak L. Lehtimäki A. Bourdin S. Korn E. Zervas Z. Csoma D. Lúðvíksdóttir M. Butler G.W. Canonica I. Grisle K. Bieksiene A. Ten Brinke P. Kuna C. Chaves Loureiro N.M. Nenasheva Z. Lazic S. Škrgat D. Ramos-Barbon J. Leuppi B. Gemicioglu A. Bossios C.M. Porsbjerg E.H. Bel R. Djukanovic R. Louis Heterogeneity in the use of biologics for severe asthma in Europe: a SHARP ERS study ERJ Open Res 8 10.1183/23120541.00273-2022 36299366 9589318 00273–2022
P. Juntunen P. Salmela J. Pakkasela J. Karjalainen L. Lehtimäki Diagnoses and prescription patterns among users of medications for obstructive airway diseases in Finland BMC Pulm Med 24 10.1186/s12890-024-02870-9 38297257 10829254 64
C.M. Averell F. Laliberté M.S. Duh J.W. Wu G. Germain S. Faison Characterizing real-world use of Tiotropium in asthma in the USA J Asthma Allergy 12 309 21 10.2147/JAA.S216932 31632091 6789414
J.R. Hurst M. Dilleen K. Morris S. Hills B. Emir R. Jones Factors influencing treatment escalation from long-acting muscarinic antagonist monotherapy to triple therapy in patients with COPD: a retrospective THIN-database analysis Int J Chron Obstruct Pulmon Dis 13 781 92 10.2147/COPD.S153655 29551894 5842770
D.L. Vetrano A. Zucchelli E. Bianchini C. Cricelli A. Piraino M. Zibellini A. Ricci G. Onder F. Lapi Triple inhaled therapy in COPD patients: determinants of prescription in primary care Respir Med 154 12 7 10.1016/j.rmed.2019.05.022 31202120
M. Cazzola P. Rogliani M.G. Matera The latest on the role of LAMAs in asthma J Allergy Clin Immunol 146 1288 91 10.1016/j.jaci.2020.06.014 32603663
M.S. Magnoni M. Latorre G. Bettoncelli M.G. Sanchez-Herrero A. Lopez E. Calvo A. Rizzi M. Caminati G. Senna P. Paggiaro Asthma control in primary care: the results of an observational cross-sectional study in Italy and Spain World Allergy Organ J 10 10.1186/s40413-017-0144-5 28413571 5382476 13
G. Cerimoniale P. Becherucci M.C. Verga G. Di Mauro L. Indinnimeo A. Villani M. Tosca G.L. Marseglia M. Duse P. Biasci M. Doria D. Peroni G. Piacentini M. Di Cicco G. Pozzobon R. Lubrano Inhaled corticosteroids use in childhood respiratory diseases: an Italian survey on pediatricians’ prescription habits Ital J Pediatr 47 10.1186/s13052-021-00988-8 33588923 7885514 34
