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Tiotropium – what role in asthma?

Tiotropium solution for inhalation (Spiriva Respimat – Boehringer Ingelheim) is the first long-acting muscarinic antagonist to be marketed in the UK for the management of asthma.1 It is licensed as add-on maintenance bronchodilator treatment in adults with asthma who are using an inhaled corticosteroid (≥800μg budesonide/day or equivalent) and a long-acting beta2 agonist, and who have had one or more severe exacerbations in the previous year.2 This corresponds to use at step 4 of both the British asthma guideline and the Global Initiative for Asthma (GINA) strategy for the treatment of asthma in adults.3,4 Here we consider the evidence for tiotropium in the management of asthma and whether it offers any advantages over existing therapeutic options at step 4.