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KMID : 1141720220100020071
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폐쇄성폐질환
2022 Volume.10 No. 2 p.71 ~ p.74
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Who can get the most benefit from triple therapy in Korean asthmatics?
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Yoon Sun-Young
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Abstract
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Muscarinic antagonists, which were already used in the treatment of asthma in the 1800s, have been mainly recognized as the treatment for COPD until recently. As evidence has been accumulating that cholinergic signaling plays an important role in asthma pathogenesis, muscarinic antagonists as an asthma treatment are receiving attention again. As Tiotropium was reported for the first time among LAMA to improve the frequency of acute exacerbation and lung function in asthma, the current guidelines recommend tiotropium as an addon treatment for moderate to severe asthma over 6 years of age. Since then, triple therapy using LAMA preparations has been developed and used in the clinical field. However, evidence of its effectiveness in improving quality of life is lacking. Triple therapy has been attempted mainly for patients with moderate-to-severe asthma, but there is still no clear indication for which asthma phenotype can expect the optimal effect. In large number RCTs that did not exclude existing asthmatics, it was reported that the use of triple therapy in COPD patients had an effect on the reduction of all-cause mortality. Thus, asthma-COPD overlap (ACO) can be considered as a good treatment target. In addition, a benefit in the T2 low asthma phenotype, where there are not many treatment options to choose, are also reported. In contrary, there are results that reduce outcomes such as acute exacerbation regardless of T2 status such as blood eosinophils and serum IgE levels, so further research is needed to select a more suitable patient group for triple therapy.
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KEYWORD
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Asthma, triple therapy, Long-acting muscarinic antagonist
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