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For patients with asthma that is not controlled on low-dose inhaled corticosteroids (ICs), guidelines recommend doubling the IC dose or adding a long-acting β-agonist (LABA). Inhaled anticholinergics are first-line agents for patients with chronic obstructive pulmonary disease (COPD) but have not been well studied in patients with asthma.
In an NIH-sponsored, double-blind three-way–crossover randomized trial, 210 adults with uncontrolled asthma who were receiving low-dose ICs (beclomethasone, 80 µg twice daily) were treated sequentially with addition of a LABA (salmeterol), addition of a long-acting anticholinergic agent (tiotropium; Spiriva), or a doubled IC dose. Each arm lasted 14 weeks. Both tiotropium and salmeterol were superior to dou…