A meta-analysis of studies adding a long-acting muscarinic antagonist (LAMA) to treatment with an inhaled corticosteroid finds less risk of asthma exacerbation than with placebo add-on, but not less than with combinations of corticosteroid and long-acting beta-agonists (LABA).

Diana Sobieraj, PharmD, Department of Pharmacy Practice, University of Connecticut School of Pharmacy, and colleagues point out that current treatment guidelines which recommend stepwise escalation with addition of LABA to inhaled corticosteroids have not accounted for the utility of LAMA.

“If control remains suboptimal (after the LABA addition), options include further increasing the inhaled corticosteroids dose and adding adjuncts such as biologics or oral corticosteroids,” researchers wrote. “Such therapies expose patients to systemic effects of drugs and thus carry the risk of more significant adverse effects.”