- Long-acting muscarinic antagonists (LAMAs) as monotherapy are frequently prescribed in patients with asthma and are associated with an increased risk of exacerbations.
- The findings highlight the need to check for use of inhaled corticosteroid (ICS) when prescribing LAMAs.
Why this matters
- LAMAs are indicated as add-on treatment in patients with asthma; their use alone remains controversial.
- ALPACA study: a cohort analysis in the Integrated Primary Care Information database included patients with asthma aged 6-50 years (n=66,508) who were using LAMA therapy during follow-up.
- Treatment was categorized into LAMA monotherapy, dual therapy (LAMA + ICS), or triple therapy (LAMA + ICS + long-acting beta-agonist).
- Funding: None disclosed.
- 38.7% of patients were LAMA monotherapy users, 15.4% were double therapy users, and 46.0% were triple therapy users.
- Among LAMA users, those receiving monotherapy had a relative severe asthma exacerbation risk of 1.58 (95% CI, 0.52-4.77; P=.42) vs those receiving double therapy.
- After excluding triple therapy users, the relative risk of severe exacerbations increased to 5.72 (95% CI, 1.39-23.62; P=.02).
- Other risk factors for severe exacerbations among all LAMA users were female sex (relative risk [RR], 1.63; 95% CI, 1.10-2.42; P=.016) and history of previous exacerbations (RR, 1.81; 95% CI, 1.63-2.00; P<.001>
- Observational design.