Tiotropium for Adults with Inadequately Controlled Persistent Asthma

Adams, Katie S.; Lowe, Denise

doi:10.1345/aph.1r502

Cited by 9 publications

(1 citation statement)

References 26 publications

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“… 1 Briefly, LAMA may: induce bronchodilation, or inhibit cholinergically-mediated bronchoconstriction, and with regular use inhibit the airway smooth muscle hypertrophy and hyper-responsiveness characteristic of chronic asthma; reduce cholinergically-mediated mucus secretion and inhibit goblet cell hyperplasia and mucus gland hypertrophy; and moderate leukocyte responses in the lower airways as well as proinflammatory gene expression by airway smooth muscle and bronchial epithelium. In addition, LAMA such as tiotropium may act as steroid-sparing agents in patients with severe or poorly controlled asthma, 5 , 6 which may alleviate some of the burden of corticosteroid use on health-related quality of life in these patients. 7 …”

Section: Introductionmentioning

confidence: 99%

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

Price¹,

Kaplan

Jones³

et al. 2015

JAA

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BackgroundRandomized controlled trials indicate that addition of a long-acting muscarinic antagonist (LAMA) such as tiotropium may improve asthma control and reduce exacerbation risk in patients with poorly controlled asthma, but broader clinical studies are needed to investigate the effectiveness of LAMA in real-life asthma care.MethodsMedical records of adults with asthma (aged ≥18 years) prescribed tiotropium were obtained from the UK Optimum Patient Care Research Database for the period 2001–2013. Patients diagnosed with chronic obstructive pulmonary disease were excluded, but no other clinical exclusions were applied. Two primary outcomes were compared in the year before (baseline) and the year after (outcome) addition of tiotropium: exacerbations (asthma-related hospital emergency department attendance or inpatient admission, or acute oral corticosteroid course) and acute respiratory events (exacerbation or antibiotic prescription with lower respiratory consultation). Secondary outcomes included lung function test results and short-acting β2 agonist usage. The Wilcoxon signed-rank test was used for variables measured on the interval scale, the marginal homogeneity test for categorized variables, and the paired t-test for lung function indices.ResultsOf the 2,042 study patients, 83% were prescribed an inhaled corticosteroid and 68% a long-acting β2 agonist during the baseline year; 67% were prescribed both. Comparing baseline and outcome years, the percentage of patients having at least one exacerbation decreased from 37% to 27% (P<0.001) and the percentage having at least one acute respiratory event decreased from 58% to 47% (P<0.001). There were no significant changes in lung function, and usage of short-acting β2 agonists (in salbutamol/albuterol equivalents) increased from a median (interquartile range) of 274 (110, 548) to 329 (110, 603) μg/day (P=0.01).ConclusionIn this real-life asthma population, addition of LAMA therapy was associated with significant decreases in the incidence of exacerbations and antibiotic prescriptions for lower respiratory tract infections in the following year.

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Section: Introductionmentioning

confidence: 99%

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

Price¹,

Kaplan

Jones³

et al. 2015

JAA

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Tiotropium added to low- to medium-dose inhaled corticosteroids (ICS) versus low- to medium-dose ICS alone for adults with mild to moderate uncontrolled persistent asthma: A systematic review and meta-analysis

2018

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Role of anticholinergics in asthma management

Rogers

Hanania

2015

Current Opinion in Pulmonary Medicine

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Accumulating evidence supports the use of inhaled LAMAs as an add-on therapy in patients with asthma, who remain symptomatic despite guideline-based therapy with ICS with or without LABAs. Further studies are warranted to help define mechanisms of action of LAMAs, apart from their role as bronchodilators, and determine how these other actions impact asthma outcomes over time. Furthermore, future studies need to examine the long-term efficacy and safety of LAMAs in asthma and identify a subgroup of patients who would benefit from such therapies to facilitate early, personalized therapy.

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Tiotropium for Adults with Inadequately Controlled Persistent Asthma

Cited by 9 publications

References 26 publications

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

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

Tiotropium added to low- to medium-dose inhaled corticosteroids (ICS) versus low- to medium-dose ICS alone for adults with mild to moderate uncontrolled persistent asthma: A systematic review and meta-analysis

Role of anticholinergics in asthma management

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