Abstract

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.