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Although antimuscarinics were used in the maintenance treatment of asthma over a century ago, after a long time (since 2014), it has been recommended to be used as an add-on long-acting antimuscarinic agent (LAMA) therapy in the maintenance treatment of asthma. The airway tone controlled by the vagus nerve is increased in asthma. Allergens, toxins, or viruses cause airway inflammation and inflammation-related epithelial damage, increased sensory nerve stimulation, ganglionic and postganglionic acetylcholine (ACh) release by inflammatory mediators, intensification of ACh signaling at M1 and M3 muscarinic ACh receptors (mAChRs), and dysfunction of M2 mAChR. Optimal anticholinergic drug for asthma should effectively block M3 and M1 receptors, but have minimal effect on M2 receptors. Tiotropium, umeclidinium, and glycopyrronium are anticholinergic agents with this feature. Tiotropium has been used in a separate inhaler as an add-on treatment to inhaled corticosteroid (ICS)\/long-acting \u03b22-agonist (LABA), and glycopyrronium and umeclidinium have been used in a single inhaler as a combination of ICS\/LABA\/LAMA in asthma in recent years. Guidelines recommend this regimen as an optimization step for patients with severe asthma before initiating any biologic or systemic corticosteroid therapy. In this review, the history of antimuscarinic agents, their effectiveness and safety in line with randomized controlled trials, and real-life studies in asthma treatment will be discussed according to the current data.<\/jats:p>","DOI":"10.1089\/jamp.2022.0059","type":"journal-article","created":{"date-parts":[[2023,7,10]],"date-time":"2023-07-10T12:06:18Z","timestamp":1688990778000},"page":"189-209","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":6,"title":["The Role of Long-Acting Antimuscarinic Agents in the Treatment of Asthma"],"prefix":"10.1177","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2786-8489","authenticated-orcid":false,"given":"Bahar","family":"Arslan","sequence":"first","affiliation":[{"name":"Division of Immunology and Allergy, Department of Chest Diseases, Erciyes University School of Medicine, Kayseri, Turkey."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2368-3401","authenticated-orcid":false,"given":"G\u00fclden Pa\u00e7ac\u0131","family":"\u00c7etin","sequence":"additional","affiliation":[{"name":"Division of Immunology and Allergy, Department of Chest Diseases, Erciyes University School of Medicine, Kayseri, Turkey."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6023-6291","authenticated-orcid":false,"given":"\u0130nsu","family":"Yilmaz","sequence":"additional","affiliation":[{"name":"Division of Immunology and Allergy, Department of Chest Diseases, Erciyes University School of Medicine, Kayseri, Turkey."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2023,8,14]]},"reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2018.04.013"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(19)32215-9"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.01247-2017"},{"key":"e_1_3_5_5_2","unstructured":"Global Initiative for Asthma Global Strategy for Asthma Management and Prevention. 2022. 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