The evolving role of tiotropium in asthma

Abstract

Tiotropium is a long-acting muscarinic antagonist (LAMA) that exerts its bronchodilatory effect by blocking endogenous acetylcholine receptors in the airways. Its safety and efficacy are well established for the treatment of COPD, and it is now being recognized for its role in improving lung function and control in asthma. This review discusses the evolving role of tiotropium delivered by the Respimat® in patients across the range of asthma severities and ages, and provides an overview of safety and efficacy data. Tiotropium is the only LAMA currently approved for the treatment of asthma, and evidence from a large-scale clinical trial program, including several Phase III studies in adults, has demonstrated that tiotropium improves lung function and asthma control, with a safety profile comparable with that of placebo. Clinical trials in adolescent patients (aged 12–17 years) have also shown improvements in lung function and trends toward improved asthma control. Of note, the efficacy and safety profiles are consistent regardless of baseline characteristics and phenotype. Given the large and growing body of evidence, it is likely that as clinical experience with tiotropium increases, this treatment may possibly emerge as the key choice for add-on therapy to inhaled corticosteroids/long-acting β2-agonists, and in patients who do not tolerate long-acting bronchodilators or other medications, in the future.

Still Fighting for Breath: a patient survey of the challenges and impact of severe asthma

“…Consequently, in the past decade, various steps have been taken to improve the quality of life of asthma patients. These include: implementation of laws banning smoking in public spaces [19, 20], introducing new treatments such as monoclonal antibody-based therapies [21], and guideline-recommended new indication of LAMAs [22] for the effective treatment of patients with asthma. After a decade, our results show that patients with asthma still have a poor quality of life and experience symptoms that affect their daily lives.…”

Tiotropium for the Treatment of Asthma: Patient Selection and Perspectives

“…A comprehensive Phase III study programme detailed below, and summarized in Table 1 [ 20 ], has demonstrated the safety and efficacy of tiotropium in adult patients with mild, moderate, and severe asthma. The majority of the Phase III trials have evaluated tiotropium in the Respimat form, with the Tiotropium Bromide as an Alternative to Increased Inhaled Corticosteroid in Patients Inadequately Controlled on a Lower Dose of Inhaled Corticosteroid study (TALC Study, NCT00565266) being one of the exceptions.…”

“…In both studies, tiotropium Respimat was well tolerated with comparable adverse event rates across treatment and placebo groups [ 37 , 38 ]. There are further five Phase III clinical trial studies in the paediatric population ( Table 2 [ 20 ]), which are discussed in detail below.…”

“… ACQ-7, 7-question Asthma Control Questionnaire; CI, confidence interval; FEV1, forced expiratory volume in 1 second; FVC, forced vital capacity; HR, hazard ratio; ICSs, inhaled corticosteroids; NS, not significant; SD, standard deviation. Table reproduced from E. R. McIvor and R. A. McIvor [ 20 ], under the Creative Commons Attribution License/public domain. …”

“… ICSs, inhaled corticosteroids; LABA, long-acting β 2 -agonist. Table reproduced from E. R. McIvor and R. A. McIvor [ 20 ], under the Creative Commons Attribution License/public domain. …”