Patients with asthma who are suboptimally responsive to inhaled corticosteroids (ICS) and long-acting β₂-agonists (LABAs) are frequently exposed to oral corticosteroids and high-dose ICS, which can lead to significant side effects. Long-acting muscarinic antagonists (LAMAs) have demonstrated efficacy and safety in a subset of these patients. This review summarizes the results of key studies using LAMAs in patients with asthma aged 12 years or older. LAMA as an add-on treatment improved lung function and asthma control in patients with uncontrolled asthma across studies. The efficacy of LAMAs as an add-on to ICS was superior to that of placebo and ICS dose escalation and comparable with that of LABAs. LAMA plus ICS plus LABA provided modest improvements in bronchodilation and increased the time to first severe exacerbation versus ICS plus LABA. Single-inhaler triple therapy was associated with decreased health care resource utilization and improved cost-effectiveness versus multiple inhalers. LAMAs were generally well tolerated; asthma exacerbations, bronchitis, and nasopharyngitis were common adverse events with LAMA in combination with ICS alone or ICS plus LABA. Thus, the overall evidence presented in this review supports the use of add-on LAMA treatment as a reasonable option in patients with asthma uncontrolled with ICS plus LABA or ICS alone.

对吸入皮质类固醇 (ICS) 和长效 β2 反应欠佳的哮喘_患者-激动剂 (LABAs) 经常暴露于口服皮质类固醇和高剂量 ICS，这可能导致显着的副作用。长效毒蕈碱拮抗剂 (LAMAs) 已在这些患者的一部分中证明了疗效和安全性。本综述总结了在 12 岁或以上哮喘患者中使用 LAMA 的关键研究结果。LAMA 作为一种附加治疗改善了研究中未控制哮喘患者的肺功能和哮喘控制。LAMAs 作为 ICS 的附加物的疗效优于安慰剂和 ICS 剂量递增，并且与 LABAs 的疗效相当。与 ICS 加 LABA 相比，LAMA 加 ICS 加 LABA 在支气管扩张方面提供了适度的改善，并增加了首次严重恶化的时间。与多吸入器相比，单吸入器三联疗法与降低医疗资源利用率和提高成本效益有关。LAMA 的耐受性普遍良好；哮喘发作、支气管炎和鼻咽炎是 LAMA 联合 ICS 单独或 ICS 联合 LABA 的常见不良事件。因此，本综述中提供的总体证据支持使用附加 LAMA 治疗作为 ICS 加 LABA 或单独 ICS 无法控制的哮喘患者的合理选择。