Tiotropium in children and adolescents with asthma

Abstract

Background: Asthma is a major cause of morbidity in children, despite the availability of various treatments. In adults, tiotropiumda long-acting muscarinic antagonistdas add-on therapy to an inhaled corticosteroid with or without a long-acting b 2 -agonist provides clinical benefit with a safety profile similar to placebo.Objective: To review published evidence on the efficacy and safety of tiotropium as add-on a long-acting muscarinic antagonist therapy in children and adolescents with asthma that is uncontrolled despite use of an inhaled corticosteroid with or without additional controller medication(s). Methods: We searched PubMed from inception until June 12, 2018, for randomized controlled trials of children and adolescents aged 1 to 17 years treated with tiotropium and reporting a primary outcome of any pulmonary function test and a secondary outcome of adverse events. Results: Overall, 7 randomized controlled trials of 1902 preschool children (aged 1-5 years; n ¼ 102), schoolage children (aged 6-11 years; n ¼ 905), and adolescents (aged 12-17 years; n ¼ 895) with moderate to severe asthma were included in the analysis. Once-daily tiotropium (5, 2.5, or 1.25 mg) improved lung function parameters, including peak and trough forced expiratory volume in 1 second, vs placebo. Commonly reported adverse events across treatment groups included asthma worsening or exacerbations, decreased peak expiratory flow rate, nasopharyngitis, viral respiratory tract infection, and respiratory tract infection. Conclusion: Once-daily tiotropium as add-on therapy is efficacious and safe in adolescents and children with moderate to severe asthma. These results support the expanded indication by regulatory authorities for add-on tiotropium in patients 6 years or older.

Tiotropium bromide as adjunct therapy in children with asthma: a clinical experience

“…It appeared particularly effective in decreasing the severity and frequency of asthma exacerbations as well as diminishing chronic symptoms, particularly moist cough, and bronchial secretions. These observations, predominantly documented in preschoolers and children under 12 years, are in line with a systematic review of 1902 children with asthma aged 1 to 17 years with moderate to severe symptomatic asthma, of which nearly half were aged 6 to 11 years, also attesting to significantly reduced chronic symptoms, improved lung function, and decreased exacerbation frequency [ 8 ]. More than 90% of parents/patients and all physicians mentioned they would try tiotropium again.…”

Inhaled long-acting muscarinic antagonists in asthma – A narrative review

“…Overall, therefore, the effect on lung function of adding tiotropium seems at least as good as salmeterol. The results from RCTs show that tiotropium is effective in adults across the ranges of asthma severity from GINA Step 2 to Step 5 [45], and is effective and well tolerated in adolescents and children with moderate to severe asthma [46].…”

Correlation Meta-Analysis of the Efficacy of Inhaled Corticosteroids in Children with Asthma Based on Smart Medical Health

“…The results of the reinvestigation in 2006 were 0.35%–4.38%, an average of 2.34%, and an average increase of 74.84% over the past 10 years. Among them, Shanghai is 5.24%, currently ranking first in the country [ 11 , 12 ]. As humans continue to transform and pollute the Earth, a series of changes will occur in the current atmospheric environment, biological species and ecology, and dietary structure.…”