Tiotropium Use in Pediatric Patients With Asthma or Chronic Cough

Cook, Anna; Kinane, T. Bernard; Nelson, Benjamin

doi:10.1177/0009922814525836

Cited by 6 publications

(5 citation statements)

References 9 publications

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“…In a case series of 71 paediatric patients, tiotropium was shown to be beneficial in 3 distinct subgroups: as add-on therapy to asthmatics on maximal maintenance medication, as an alternative to high-dose ICS in patients experiencing significant side effects, and in subjects with chronic productive cough as predominant symptom [ 34 ]. Interestingly, almost half of the patients who started tiotropium were able to decrease the dose of ICS or stop the use of LABA.…”

Section: Resultsmentioning

confidence: 99%

Tiotropium in asthma: back to the future of anticholinergic treatment

Bonini

Scichilone

2017

Clin Mol Allergy

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Asthma is among the most common chronic diseases worldwide; however, despite progresses in the understanding of the patho-physiological mechanisms and advances in the development of new therapeutic options and strategies, the disease remains uncontrolled in a not trivial proportion of subjects. Thus, the need of new molecules to treat the underlying biological and functional abnormalities and to control symptoms is strongly advocated by clinicians. In this scenario, the most recent GINA guidelines have included the use of tiotropium bromide in the most severe and uncontrolled forms of the disease, in addition to treatment with inhaled corticosteroid plus long acting beta adrenergic agents. Indeed, a large body of evidence has accumulated to support the use of tiotropium bromide in asthma. The current review paper provides a state of the art systematic revision of findings on the efficacy and safety of tiotropium in the adult and paediatric asthma population. To this aim, electronic searches were undertaken in the most common scientific databases from the date of inception to March 2017. Robust and high quality evidence showed that tiotropium is effective and safe in both adults and children/adolescents. Predictive markers of response have been also suggested, as well as cost–benefit analyses reported. The tiotropium bronchodilator effect seems to be not solely related to the reduction of the smooth muscle tone. However, the observations on anti-inflammatory properties or reduction in mucus production, despite highly interesting, have been only demonstrated in in vitro studies and animal models, therefore advocating for further specifically designed investigations.

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Section: Resultsmentioning

confidence: 99%

Tiotropium in asthma: back to the future of anticholinergic treatment

Bonini

Scichilone

2017

Clin Mol Allergy

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“…In a case series report, the use of tiotropium was described in 71 patients aged 7-18 years who were diagnosed with asthma or chronic cough and were unresponsive to bronchodilators or ICS [68]. More than half of these patients showed a subjective improvement in cough, wheeze, or dyspnea on exertion after two weeks of therapy, and of 30 patients who had spirometry records, 73% had some improvement in FEV 1 .…”

Section: Real-life Evidencementioning

confidence: 99%

Tiotropium in asthma: From bench to bedside

Mansfield¹,

Bernstein

2019

Respiratory Medicine

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Tiotropium is a long-acting muscarinic antagonist approved for maintenance treatment of asthma in children, adolescents, and adults in the United States, and recommended as add-on treatment for uncontrolled asthma despite treatment with inhaled corticosteroids and/or long-acting beta-2 agonists. This review traces the journey of tiotropium from its historical origins through early preclinical testing to human clinical trials and real-life studies. Data sources: A search was performed in PubMed using search terms 'tiotropium' and 'asthma.' Relevant references cited in those articles were reviewed. Study selections: English language articles published from December 2008-December 2018 were screened. Articles evaluating the efficacy, cost-effectiveness, real-life evidence, and steroid-sparing effect of tiotropium with inadequately controlled asthma were included. Results: Anticholinergics have a long history of use in the treatment of obstructive airway diseases. Evidence indicates that tiotropium's mechanism of action consists of bronchodilation and diminished mucus secretion, with preclinical evidence suggesting an anti-inflammatory effect as well. Phase 2 and 3 clinical trials have demonstrated that tiotropium is efficacious and safe, resulting in significant improvements in lung function in adults, adolescents, and children across asthma severities. Emerging evidence suggests that add-on tiotropium might potentially enable reductions in inhaled corticosteroid dose in patients with uncontrolled asthma. Further, tiotropium is a cost-effective treatment option that is also effective in the clinical practice setting. Conclusions: An increasing body of evidence indicates that tiotropium can play a significant role in the treatment of patients with uncontrolled asthma.

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“…Furthermore, several recent studies have demonstrated additional benefit of tiotropium added to ICS + LABA combination therapy in patients with more severe disease(56, 57). No placebo-controlled trials using tiotropium have been published in children to date; however, a recent case-series suggests that tiotropium may have efficacy in children(58). At least two tiotropium trials are ongoing in children under 12 years of age with moderate-severe asthma (ClinicalTrials.gov ID NCT01634139 & NCT01634152).…”

Section: Emerging Therapies For Asthma In Childrenmentioning

confidence: 99%

Emerging Issues in Pediatric Asthma: Gaps in EPR-3 Guidelines for Infants and Children

Jackson

2014

Curr Allergy Asthma Rep

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There are many complexities to the treatment of infants and children with recurrent wheezing and asthma. NHLBI’s Expert Panel Report-3 (EPR3), published in 2007, provides guidance to clinicians who care for infants and children with asthma. Since that time, many important clinical trials have further informed the evidence base available to clinicians. In this manuscript, new approaches to long-term therapy, intermittent fixed-dose and dynamic dose therapies, and emerging therapies for asthma are reviewed. Further, additional gaps in guideline-base care and areas for future research are discussed.

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Tiotropium Use in Pediatric Patients With Asthma or Chronic Cough

Cited by 6 publications

References 9 publications

Tiotropium in asthma: back to the future of anticholinergic treatment

Tiotropium in asthma: back to the future of anticholinergic treatment

Tiotropium in asthma: From bench to bedside

Emerging Issues in Pediatric Asthma: Gaps in EPR-3 Guidelines for Infants and Children

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