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Long-Acting Muscarinic Antagonists Aid Asthma Care in Kids
Long-acting muscarinic antagonists (LAMAs), as add-on therapy to inhaled corticosteroids, improved peak forced expiratory volume in 1 second (FEV1) and reduced exacerbations in children younger than 12 years with moderate-to-severe asthma.
METHODOLOGY:
Researchers conducted a meta-analysis to assess the efficacy and safety of LAMAs as add-on therapy to inhaled corticosteroids in children with moderate-to-severe asthma.
They included four randomized controlled trials and two observational studies, comprising 1210 children (0.5-11 years), that evaluated tiotropium as LAMA of choice, with a median follow-up of 15 weeks.
All participants received inhaled corticosteroids both before and after screening and randomization, with mean doses ranging from 228 μg to 480 μg of budesonide or an equivalent dose.
The primary outcome was a change in FEV1. Other outcomes evaluated were peak FEV1, forced vital capacity (FVC), forced expiratory flow 25%-75% (FEF25%-75%), and asthma control assessed via interviewer-administered asthma control questionnaire (ACQ-IA) scores.
TAKEAWAY:
LAMAs at any dose significantly improved peak FEV1 (mean difference [MD], 86.16 mL; P < .01), with 5 μg tiotropium leading to a greater improvement (MD, 113.05 mL; P < .01).
< .01), with 5 μg tiotropium leading to a greater improvement (MD, 113.05 mL; < .01). FEF25%-75% demonstrated significant improvements with LAMAs (MD, 0.2518 L; 95% CI, 0.1971-0.3064; P < .01), while peak FVC showed no significant change.
< .01), while peak FVC showed no significant change. Treatment with LAMAs was associated with improved asthma control, as assessed by ACQ-IA scores (MD, -0.07; P < .01), and a reduced risk for exacerbations (risk ratio [RR], 0.75; P = .013).
< .01), and a reduced risk for exacerbations (risk ratio [RR], 0.75; = .013). Treatment with LAMAs was associated with fewer adverse events than control (RR, 0.88; P = .021). No deaths were reported, and no adverse events led to treatment discontinuation in any of the included studies.
IN PRACTICE:
'We found that LAMA as an add-on therapy to ICS [inhaled corticosteroids], with or without associated LABA [long-acting beta-agonists], is effective and safe for moderate and severe asthma in children aged 6-11, improving lung function parameters in spirometry and protecting against exacerbations,' the authors wrote.
SOURCE:
This study was led by Gabriel Bolner, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil. It was published online on May 5, 2025, in Paediatric Respiratory Reviews .
LIMITATIONS:
This study included only patients with moderate-to-severe asthma or persistent symptoms, limiting the understanding of potential benefits for children with better-controlled asthma. Additionally, only one study included children aged 5 years or younger, making this population underrepresented in the pooled analysis.
DISCLOSURES:
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. No conflicts of interest were mentioned.
