The Role of Anticholinergics in Asthma Treatment

Iako su antikolinergici prihvaćeni kao prva linija bronhodilatacijskog liječenja KOPB-a, mnogi ih liječnici tradicionalno propisuju i u astmatičara. Učinkovitost ipratropija u akutnoj i stabilnoj astmi etablirana je još prije dvadesetak godina, a nekoliko recentnih ispitivanja ističe terapijski potencijal tiotropija u liječenju ove bolesti. Antikolinergici su tradicionalno klasificirani kao brohodilatatori. Na temelju istraživanja “neživčanoga” kolinergičkog sustava dišnih putova očito je da barem neki od njih (tiotropij) uz poznati mehanički, bronhorelaksacijski učinak manifestiraju i nemehaničke, protuupalne i protuproliferativne, učinke. Ovi rezultati promiču tiotropij od pukog bronhodilatatora u preparat s potencijalnim protuupalnim djelovanjem koji bi mogao modificirati tijek astme i/ili KOPB-a. Za potvrdu ovog koncepta potrebni su dodatni klinički pokusi planirani na način da se izravno dokažu navedene postavke.Although anticholinergics have been accepted as first-line bronchodilators in COPD, many physicians also prescribe them to asthmatics. The efficacy of ipratropium in acute and stable asthma was established about twenty years ago, and some recent studies emphasize the therapeutic potential of tiotropium in asthma treatment. Traditionally, anticholinergics have been classified as bronchodilators. On the basis of the research of non-neuronal cholinergic respiratory system, it is obvious that at least some of them (tiotropium) exhibit non-mechanical, anti-inflammatory, and antiproliferative effects in addition to their known mechanical and bronchorelaxing effects. These results promote tiotropium from its position of a mere bronchodilator to that of a potential anti-inflammatory agent that could modify asthma and/or COPD course. Additional clinical trials should be conducted to confirm these hypotheses