Anticholinergics in the treatment of bronchial asthma


Yu.G. Belotserkovskaya, A.G. Romanovskikh, I.P. Smirnov

Russian Medical Academy of Continuous Professional Education, Moscow, Russia
The article reveals some aspects of managing patients with bronchial asthma (BA), in which the possibility of achieving complete control of the disease remains a difficult task, despite the use of the maximum amount of recommended basic therapy (medium/high doses of inhaled glucocorticosteroids – IGCS in combination with long-acting β2-agonists – LABA). The exclusion of an alternative diagnosis, the identification and elimination of various factors, including concomitant chronic diseases, are important components of the algorithm for managing a patient with an uncontrolled disease. The patient’s lack of adherence to the prescribed treatment and violation of the technique of inhalation maneuver can also be the causes of the ineffectiveness of BA treatment. Antileukotriene drugs, tiotropium bromide, biological and drugs can be used as additional therapy at different stages of treatment. The effectiveness of tiotropium deli­vered via Respimat device is determined by various clinical and functional aspects, such as an increase in external respiration function, a decrease in daily symptoms, a decrease in the risk of exacerbations, and an improvement in the quality of life and control of disease in general. Efficacy and good tolerability of tiotropium make it possible to use it in moderate and severe asthma as an addition to the therapy with IGCS/LABA, regardless of BA phenotype.
Keywords: severe bronchial asthma, uncontrolled bronchial asthma, refractory bronchial asthma, tiotropium, Respimate

About the Autors

Corresponding author: Yulia G. Belotserkovskaya, PhD, Associate Professor at the Department of Pulmonology, Russian Medical Academy of Continuous Professional Education, Moscow, Russia; e-mail:
Address: 2/1, Build. 1, Barrikadnaya Street, Moscow 123995, Russian Federation

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