Tiotropium in Asthma Poorly Controlled with Standard Combination Therapy

Kerstjens, Huib A. M.; Engel, Michael; Dahl, Ronald; Paggiaro, Pierluigi; Beck, Ekkehard; Vandewalker, Mark; Sigmund, Ralf; Seibold, Wolfgang; Moroni-Zentgraf, Petra; Bateman, Eric D.

doi:10.1056/nejmoa1208606

Cited by 596 publications

(573 citation statements)

References 13 publications

Supporting

Mentioning

502

Contrasting

Unclassified

Order By: Relevance

“…After 16 weeks, and 8, 12, 18 and 24 months of treatment with omalizumab, lung function assessed as mean change from baseline in FEV 1 improved by 205 ml, 215 ml, 273 ml, 200 ml and 137 ml, respectively. The effect of add-on omalizumab to high-dose ICS/LABA on FEV 1 is comparable to what was reported for add-on tiotropium in patients with poorly controlled asthma [24].…”

Section: Discussionsupporting

confidence: 82%

Real-world effectiveness and safety of omalizumab in patients with uncontrolled severe allergic asthma from the Czech Republic

Kirchnerová¹,

Valena²,

Novosad³

et al. 2019

pdia

View full text Add to dashboard Cite

A b s t r a c tIntroduction: This was a sub-group analysis of patients with uncontrolled persistent allergic asthma (AA) in the healthcare setting of the Czech Republic, from a global non-interventional, 2-year post-marketing, observational eXpeRience registry. Aim: To evaluate the real-life effectiveness and safety of omalizumab. Material and methods: Patients with uncontrolled persistent AA (currently defined by the Global Initiative for Asthma (GINA) as uncontrolled severe AA) who started omalizumab treatment 15 weeks before inclusion in the registry were analysed for physicians' global evaluation of treatment effectiveness (GETE), asthma symptoms, corticosteroid use, exacerbation rate, asthma control, quality of life, healthcare utilisation and safety during a 24-month observation period. Results: One hundred and fourteen patients from the Czech Republic were enrolled in the eXpeRience registry. A total of 88.9% of the patients were evaluated as responders to omalizumab according to the GETE assessment at week 16. From baseline to month 24: mean change in forced expiratory volume in 1 s (FEV 1 ) was 137 ml and the daily dose of OCS decreased (11.6 mg to 6.4 mg prednisolone equivalent); the percentage of patients with no severe clinically significant exacerbations increased (29.5% to 95.1%); Asthma Control Test scores improved (12.4 to 17.3) and mean total number of days of asthma-related medical healthcare use decreased (6.8 days to 0.4 days). Conclusions: The results of this subgroup analysis support the evidence that add-on omalizumab therapy is effective and well tolerated for management of patients with uncontrolled persistent AA in the Czech Republic. Global evaluation of treatment effectiveness assessment is a reliable predictor of long-term response to omalizumab treatment.

show abstract

Section: Discussionsupporting

confidence: 82%

Real-world effectiveness and safety of omalizumab in patients with uncontrolled severe allergic asthma from the Czech Republic

Kirchnerová¹,

Valena²,

Novosad³

et al. 2019

pdia

View full text Add to dashboard Cite

show abstract

“…In patients taking high doses of ICSs and LABAs, the addition of tiotropium bromide provided improvements in FEV1, reduced asneeded use of SABAs and modestly reduced the risk of a severe exacerbation [219,221]. There have been no studies of tiotropium in children with asthma.…”

Section: Long-acting Muscarinic Antagonistsmentioning

confidence: 99%

International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma

et al. 2013

Self Cite

View full text Add to dashboard Cite

Severe or therapy-resistant asthma is increasingly recognised as a major unmet need. A Task Force, supported by the European Respiratory Society and American Thoracic Society, reviewed the definition and provided recommendations and guidelines on the evaluation and treatment of severe asthma in children and adults.A literature review was performed, followed by discussion by an expert committee according to the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach for development of specific clinical recommendations.When the diagnosis of asthma is confirmed and comorbidities addressed, severe asthma is defined as asthma that requires treatment with high dose inhaled corticosteroids plus a second controller and/or systemic corticosteroids to prevent it from becoming “uncontrolled” or that remains “uncontrolled” despite this therapy. Severe asthma is a heterogeneous condition consisting of phenotypes such as eosinophilic asthma. Specific recommendations on the use of sputum eosinophil count and exhaled nitric oxide to guide therapy, as well as treatment with anti-IgE antibody, methotrexate, macrolide antibiotics, antifungal agents and bronchial thermoplasty are provided.Coordinated research efforts for improved phenotyping will provide safe and effective biomarker-driven approaches to severe asthma therapy.

show abstract

“…Furthermore, tiotropium exhibited a possible anti-inflammatory effect, as shown by a limited reduction in exhaled NO [45]. A recent study illustrated that poorly controlled asthmatics on inhaled glucocorticoids and LABAs had modest sustained bronchodilation, and an increased time to first exacerbation episode with the addition of tiotropium [46]. This dual combination of LABA/ LAMA (long-acting muscarinic antagonists) does not clearly reveal the cardiovascular side effects, and its use in clinical practice is awaiting further large randomized studies.…”

Section: Anticholinergicsmentioning

confidence: 99%

Severe Asthma: Moving from Phenotype to Endotype Classification with Updates on Treatment

Noujeim¹,

Bou‐Khalil²

2016

J Nurs Care

View full text Add to dashboard Cite

Asthma has classically been categorized into several phenotypes to address the complexities of this disease. However, phenotypes only cover the clinically relevant aspects of the disease, but do not address the relationship between the disease and its etiology and pathophysiology. This led to the development of the term "endotypes" which links key pathogenic mechanisms with asthma phenotypes, and ultimately leads to better selection of treatment resulting in improved response. Although the exact pathogenesis of asthma is still under investigation, targeted-therapy based on asthma phenotypes and endotypes has shown some success, and the future appears promising for patients suffering from severe asthma since treatment is being tailored according to individual biology. We review in this manuscript the best evidence and updates currently available in the classification and treatment recommendations for severe asthma.

show abstract

Tiotropium in Asthma Poorly Controlled with Standard Combination Therapy

Cited by 596 publications

References 13 publications

Real-world effectiveness and safety of omalizumab in patients with uncontrolled severe allergic asthma from the Czech Republic

Real-world effectiveness and safety of omalizumab in patients with uncontrolled severe allergic asthma from the Czech Republic

International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma

Severe Asthma: Moving from Phenotype to Endotype Classification with Updates on Treatment

Contact Info

Product

Resources

About