<p>Frequency of Tiotropium Bromide Use and Clinical Features of Patients with Severe Asthma in a Real-Life Setting: Data from the Severe Asthma Network in Italy (SANI) Registry</p>

Abstract

Purpose Patients with uncontrolled asthma despite high doses of inhaled corticosteroid therapy plus another controller are defined as severe asthmatics. Tiotropium bromide respimat (TBR) is the only long-acting muscarinic antagonists (LAMA) approved for severe asthma. The aim of this study was to explore the frequency of severe asthmatics treated with TBR and characterize their clinical features in a real-life, registry-based setting. Materials and Methods Baseline data from the Severe Asthma Network in Italy (SANI) registry have been analyzed to determine the use of TBR and other LAMA, and to compare clinical, functional and inflammatory features associated with the use of LAMA. Results Among a total of 698 enrolled patients, 35.9% were treated with LAMA (23.3% TBR, 4.5% tiotropium bromide handihaler, 4.5% aclidinium, 3.4% glycopyrronium bromide 0.3% umeclidinium bromide). Age of asthma onset was higher in patients taking LAMA, whom, compared to others were more frequently former smokers. They also had a higher annual exacerbation rate, experienced worst asthma control, worst disease-related quality of life and poorer lung function. Bronchiectasis was more frequently found in LAMA users (25.9% vs 13.1%). Conclusion TBR is still underused in severe asthma in a real-life setting, while a relevant proportion of patients are treated with other LAMA that are not approved for severe asthma treatment. Patients taking LAMA have features characteristic of even more severe asthma.

Open and Closed Triple Inhaler Therapy in Patients with Uncontrolled Asthma

“…A retrospective observational study demonstrated that severe asthmatics under treatment with LAMAs used to experience significantly worse asthma control and worse disease-related quality of life before LAMA initiation, based on the results of ACT, ACQ, and AQLQ [ 10 ]. These patients tended to be ex-smokers and had later-onset asthma in comparison to patients who did not receive LAMAs.…”

“…These patients tended to be ex-smokers and had later-onset asthma in comparison to patients who did not receive LAMAs. Moreover, they were often diagnosed with concomitant bronchiectasis and used to receive oral corticosteroid (OCS) treatment courses and long-term treatment with monoclonal antibodies more frequently compared with non-LAMAusers [ 10 ].…”

“…Monoclonal antibodies have been approved as an option for severe asthma management at “step 5” of GINA guidelines in both adults and children [ 8 , 9 ]. LAMAs are considered as an add-on therapy at “steps 4 and 5” of GINA guidelines, either in a single inhaler device combined with ICS and LABA (closed triple inhaler therapy, only for adults) or in a separate inhaler device (open triple inhaler therapy, for both children and adults), enriching, in this way, the physicians’ arsenal against the disease [ 3 , 10 , 11 ].…”

Mild/Moderate Asthma Network in Italy (MANI): a long-term observational study

“…An ad hoc CRF on the Web platform, REDCap, has been created. A similar database has been adopted by the Severe Asthma Network Italy (SANI), which is an ongoing project (16)(17)(18)(19)(20)(21)(22)(23)(24). Each center that participates in the MANI study will have a username and password, which allows access to a reserved area of the Web application.…”

The severe asthma registries: a way to better know and fight the disease

“…Particular attention is paid to the follow-up of patients in order to assess the natural history of the disease, the cost/benefit of new biological products, the adherence to therapy and the presence of particular disease biomarkers (8). 698 patients were enrolled by March 2019 (11). Bilò et al published in this issue of the Journal the findings about the most recent and currently largest registry in Italy, the IRSA (9).…”