The Efficacy of Tiotropium as a Steroid‐Sparing Agent in Severe Asthma

Abstract

People with severe asthma account for 5% to 10% of all asthmatic patients; however, this small group uses the majority of health care resources. Novel methods are needed to cope with the burden that this minority of patients places on the health care system. A severe asthma clinic patient, who was monitored through the University of Alberta's Virtual Asthma Clinic (Edmonton, Alberta) is presented. Despite optimization of his disease and individualized asthma education (provided by a certified asthma educator), the patient remained on oral glucocorticosteroids (OGS) to control his disease. Following optimization and stabilization, a further reduction in the dose of his OGS by the addition of the long-acting anticholinergic agent tiotropium bromide, was demonstrated. The role of tiotropium as a potential 'steroid-sparing agent' in severe refractory asthma is discussed, noting that if patients who are on OGS are not monitored for active inflammation, they may overuse the amount of prescribed systemic steroids, which can result in long-term steroid-related sequelae.

Pharmacogenomic Approaches to Asthma Treatment

“…Recently, several studies have suggested the efficacy of anticholinergics in severe asthma,32,33 and interest about the use of long-acting anticholinergics (e.g. tiotropium bromide) for asthma have increased.…”

Tiotropium improves lung function in patients with severe uncontrolled asthma: A randomized controlled trial

“…[9][10][11][12] More importantly, Peters et al 13 recently demonstrated in patients with mild-to-moderate asthma uncontrolled with only low-dose ICSs that the addition of tiotropium yielded superior improvements in morning and evening PEF, prebronchodilator FEV 1 , symptoms, and asthma control days compared with doubling the dose of ICSs. In the same study the use of tiotropium was found not to be inferior to salmeterol.…”

The Emerging Role of Tiotropium for Patients with Asthma

“…15 In 2009, a case report was published describing a 43-year-old man with adult-onset atopic asthma with an initial PEF rate of 450 L/min. 16 The patient remained symptomatic despite his regimen of daily oral corticosteroids, highdose ICS plus LABA, a leukotriene modifier, and a quickrelief SABA. He was given tiotropium 18 µg inhaled once daily.…”