Abstract
Asthma is a widespread, phenotypically heterogeneous, chronic disease characterized by inflammation and airflow obstruction, bronchial hyperresponsiveness and recurrent symptoms of respiratory discomfort. On the one hand, the treatment of asthma is based on the determination of the severity and on the control of symptoms. On the other hand, it is based on the risk management of exacerbations. The control of asthma in most patients is achieved as a result of conventional treatment with inhaled corticosteroids or a combination of them with long-acting beta-2-agonists. However, a substantial proportion of patients with difficult asthma phenotypes (severe atopic asthma, asthma and obesity, smoker’s asthma, asthma in the elderly, asthma with fixed airflow obstruction) can be refractory to the conventional therapy. Additional therapy with the long-acting anticholinergic drug such as tiotropium can optimize the control in these patients. This article describes the complex phenotypes of asthma and the clinical cases of tiotropium efficacy in therapy of such patients.
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