Consider Tiotropium or Biologics for Severe Asthma

We're getting questions about the role of tiotropium (Spiriva) or biologics (Xolair, etc) for SEVERE asthma.

These are patients who still have symptoms despite using moderate to high doses of an inhaled a long-acting beta-agonist (LABA), with or without a leukotriene modifier (montelukast, etc).

But in some patients, titrating to a high-dose inhaled steroid may not add much over lower doses...since benefits seem to plateau.

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