Asthma and Chronic obstructive pulmonary disease (COPD) are disorders that affect millions of people in Italy and continues to be major sources of global economic burden in terms of both direct and indirect costs. 

Given that asthma cannot be cured or effectively prevented, attempts at reducing costs should focus on better disease management. In 2019, GINA Guidelines introduced Tiotropium, the first long-acting muscarinic antagonist (LAMA) for the therapy of patients with symptomatic asthma despite treatment with a high dose of inhaled glucocorticosteroids (ICSs) and long-acting β2-agonists (LABAs). Tiotropium delivered with the Respimat® inhaler is the only LAMA approved for the treatment of severe asthma. Added to usual care it improves lung function, asthma control, the frequency of exacerbations and is cost effective in patients who remain uncontrolled despite treatment with high-dose ICS/LABA.

COPD, a lung disease characterized by a persistent, progressive airflow limitation, is a major cause of chronic morbidity and mortality worldwide, and its epidemiological, clinical, and socioeconomic impact is progressively increasing. Based on GOLD guidelines, several different types of pharmacologic treatment are used in the management of COPD, with the treatment goal to alleviate symptoms and prevent or reduce the severity of exacerbations. Tiotropium, alone or in combination with olodaterol, has been shown to reduce exacerbations, improve quality of life and has the potential to reduce the economic burden of COPD in Italy.

The therapeutic approach followed in a specialist center, based on the application of clinical guidelines, has been shown to be a highly effective investment for the long-term management of asthma and COPD. A small increase of pharmaceutical costs per year allowed a substantial saving in terms of hospitalizations, costs related to outpatient services, and indirect costs.

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Key words: asthma, chronic obstructive pulmonary disease, guidelines, tiotropium, cost effectiveness