Long-acting muscarinic antagonist use in adults with asthma: real-life prescribing and outcomes of add-on therapy with tiotropium bromide

Price, David; Kaplan, Alan; Jones, Rupert; Freeman, Daryl; Burden, Anne; Gould, Shuna; Ziegenweidt, Julie von; Ali, Muzammil; King, Christine; Thomas, Mike

doi:10.2147/jaa.s76639

Cited by 19 publications

(14 citation statements)

References 17 publications

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“…However, improvements in Asthma Control Questionnaire (ACQ)-7 and Asthma Quality of Life Questionnaire (AQLQ) scores were small and inconsistent, and did not reach a clinically important difference. Similar results were reported in a real-life asthma population, where the addition of tiotropium was associated with significant decreases in the incidence of exacerbations (from 37% to 27%) and antibiotic prescriptions for lower respiratory tract infections [ 36 ]. Tiotropium (soft-mist inhaler) has recently been included as a new add-on treatment for GINA Steps 4 and 5 in patients aged ≥18 years with a history of exacerbations (Evidence A) [ 18 ].…”

Section: Treating Severe Asthma: Current Optionssupporting

confidence: 83%

An algorithmic approach for the treatment of severe uncontrolled asthma

et al. 2018

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A small subgroup of patients with asthma suffers from severe disease that is either partially controlled or uncontrolled despite intensive, guideline-based treatment. These patients have significantly impaired quality of life and although they constitute <5% of all asthma patients, they are responsible for more than half of asthma-related healthcare costs. Here, we review a definition for severe asthma and present all therapeutic options currently available for these severe asthma patients. Moreover, we suggest a specific algorithmic treatment approach for the management of severe, difficult-to-treat asthma based on specific phenotype characteristics and biomarkers. The diagnosis and management of severe asthma requires specialised experience, time and effort to comprehend the needs and expectations of each individual patient and incorporate those as well as his/her specific phenotype characteristics into the management planning. Although some new treatment options are currently available for these patients, there is still a need for further research into severe asthma and yet more treatment options.

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Section: Treating Severe Asthma: Current Optionssupporting

confidence: 83%

An algorithmic approach for the treatment of severe uncontrolled asthma

et al. 2018

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“…Medical records of adults with asthma who were prescribed tiotropium were obtained from the UK Optimum Patient Care Research Database for the period 2001–2013 [ 25 ]. Two primary outcomes were compared in the year before (baseline) and the year after (outcome) addition of tiotropium: exacerbations (i.e.…”

Section: Resultsmentioning

confidence: 99%

Tiotropium in asthma: back to the future of anticholinergic treatment

Bonini

Scichilone

2017

Clin Mol Allergy

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Asthma is among the most common chronic diseases worldwide; however, despite progresses in the understanding of the patho-physiological mechanisms and advances in the development of new therapeutic options and strategies, the disease remains uncontrolled in a not trivial proportion of subjects. Thus, the need of new molecules to treat the underlying biological and functional abnormalities and to control symptoms is strongly advocated by clinicians. In this scenario, the most recent GINA guidelines have included the use of tiotropium bromide in the most severe and uncontrolled forms of the disease, in addition to treatment with inhaled corticosteroid plus long acting beta adrenergic agents. Indeed, a large body of evidence has accumulated to support the use of tiotropium bromide in asthma. The current review paper provides a state of the art systematic revision of findings on the efficacy and safety of tiotropium in the adult and paediatric asthma population. To this aim, electronic searches were undertaken in the most common scientific databases from the date of inception to March 2017. Robust and high quality evidence showed that tiotropium is effective and safe in both adults and children/adolescents. Predictive markers of response have been also suggested, as well as cost–benefit analyses reported. The tiotropium bronchodilator effect seems to be not solely related to the reduction of the smooth muscle tone. However, the observations on anti-inflammatory properties or reduction in mucus production, despite highly interesting, have been only demonstrated in in vitro studies and animal models, therefore advocating for further specifically designed investigations.

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“…A retrospective study of 2042 adults with asthma found that, in the first year following the addition of tiotropium (93% via HandiHaler, 7% via Respimat at 5 μg), there was a decrease in the incidence of both primary outcomes of exacerbations (patients experiencing ≥1 exacerbation were decreased from 37 to 27%, p < 0.001) and respiratory events requiring antibiotic prescriptions (from 58 to 47%, p < 0.001) [ 59 ]. Unlike the earlier-presented data from the Phase III randomized trials, no significant changes in lung function were found with the addition of tiotropium; this negative finding may be related to the inclusion of smokers (∼50% had an active smoking history, whereas those with >10 pack-year smoking history were excluded from trials) and the limited control on lung function data inherent to a retrospective study including timing of the measurements with regard to time of day, or relative to tiotropium initiation [ 59 ]. In a randomized, open-label, parallel-group pragmatic trial of 1070 black adults with moderate-to-severe asthma, the effect of tiotropium HandiHaler as add-on therapy to ICSs on time to first exacerbation was compared with LABAs (salmeterol or formoterol) [ 46 ].…”

Section: Further Perspectivesmentioning

confidence: 99%

Tiotropium for the Treatment of Asthma: Patient Selection and Perspectives

Chari

McIvor

2018

Canadian Respiratory Journal

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Asthma is a chronic disease of airway inflammation with a large global burden. Despite established, guideline-based stepwise therapy, a significant proportion of patients remain symptomatic and poorly controlled. As such, there is a need for additional safe, effective, convenient, and cost-effective therapies that can be broadly applied across a range of asthma phenotypes. Tiotropium is a long-acting muscarinic antagonist (LAMA) that leads to bronchodilation by blocking endogenous acetylcholine receptors in the airways. Tiotropium has long been approved for the treatment of chronic obstructive pulmonary disease, and it has recently been recognized for its safety and efficacy in improving lung function and controlling asthma. Evidence from several Phase III trials in the adult and paediatric population has shown that tiotropium is well tolerated and significantly improves a range of endpoints as an add-on treatment to ICS therapy, regardless of baseline characteristics and clinical phenotypes. Consequently, regulatory authorities worldwide have recently licensed tiotropium as the only LAMA approved for the treatment of asthma. This review provides an overview of safety and efficacy data and discusses the use of tiotropium in patients across the range of asthma severities, ages, and phenotypes.

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Long-acting muscarinic antagonist use in adults with asthma: real-life prescribing and outcomes of add-on therapy with tiotropium bromide

Cited by 19 publications

References 17 publications

An algorithmic approach for the treatment of severe uncontrolled asthma

An algorithmic approach for the treatment of severe uncontrolled asthma

Tiotropium in asthma: back to the future of anticholinergic treatment

Tiotropium for the Treatment of Asthma: Patient Selection and Perspectives

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