A new multinational survey highlights wide variation across Europe in how respiratory specialists prescribe long-acting muscarinic antagonists (LAMAs) for severe asthma, revealing inconsistent practices and access barriers that may contribute to underuse of this therapy.
Clinicians’ Views on When to Prescribe LAMA
The study, conducted within the Severe Heterogeneous Asthma Research collaboration, Patient-centred (SHARP) network, surveyed 470 respiratory clinicians from multiple European countries between 2023 and 2024. Most participants were pulmonologists (83%), and 68% reported using specific criteria when prescribing LAMA for severe asthma. The main triggers were fixed bronchial obstruction (68%), frequent exacerbations (65%), and a history of smoking (53%).
Respondents agreed that quality of life improvement, better lung function, and fewer exacerbations were the key expected outcomes of LAMA therapy (85–95% agreement). However, opinions diverged on where to position LAMAs within treatment pathways.
Severe asthma specialists were more likely than non-specialists to prescribe LAMAs before biologic therapies (54% vs. 41%) and before oral corticosteroids (51% vs. 40%). Most clinicians, around 90%, said they aim to reduce or stop oral corticosteroids before ending LAMA treatment.
Regional Disparities in Access and Confidence
Geographic differences emerged as a significant factor influencing clinical behaviour. Clinicians in Northern and Western Europe appeared less likely to prescribe LAMAs and less confident in their benefits compared with peers in Eastern and Southern Europe.
Notably, 91% of Latvian and 67% of Lithuanian participants reported that LAMAs are not reimbursed for severe asthma, underscoring the role of policy and access barriers in shaping treatment practices.
Overall, the findings reveal persistent heterogeneity in LAMA prescription and emphasise the need for a more standardised, evidence-based approach. The authors call for clarifying LAMA’s role within precision medicine frameworks, as current international guidelines offer limited direction on their optimal use in severe asthma management.
Reference
Marcon A et al. Use of long-acting muscarinic antagonists for severe asthma: insights from clinicians in the SHARP network. Respir Res. 2025;DOI:10.1186/s12931-025-03378-4.
