A comparative study of safety and efficacy of tiotropium bromide with salbutamol in moderate persistent bronchial asthma in a tertiary care hospital

Abstract

INTRODUCTIONAsthma is derived from the Greek word meaning "to stay in order to breathe or difficulty in breathing".1 Bronchial asthma is a condition of the lungs characterized by widespread narrowing of the airways due to spasm of the smooth muscle, edema of the mucosa, and the presence of mucus in the lumen of the bronchi and bronchioles. It is caused by the local release of spasmogens and vasoactive substances in the course of an allergic reaction.2 According to World Health Organization (WHO-2010) 300 million people worldwide were affected by asthma leading to approximately 250,000 deaths per year.3 It is the most common chronic illness in childhood and is one of the most common causes of admission to the hospital among children and adults. 4Salbutamol is a fairly selective beta-2 agonist with relaxant effects on smooth muscles of bronchi and uterus. Being a non-catecholamine it is not metabolized by COMT and thus exhibits longer duration of action than isoprenaline. For immediate relief of asthma it is given by oral inhalation from a metered dose inhaler, 100 micro grams in a single dose. It can also be given orally, intra muscularly or by slow I.V injection. Sustained release tablets are also available. Inhalation causes fewer side effects than systemic administration. Tiotropium bromide has longer duration of action and shows some selectivity ABSTRACT Background: The objective of this study was to compare the safety and efficacy of tiotropium bromide with salbutamol in moderate persistent cases of bronchial asthma at tertiary care hospital. Methods:This was an open label, randomized parallel group study done in Government General Hospital, Srikakulam for a period of 12 weeks. Group-1 was given tiotropium bromide metered dose inhalational therapy 18mcg once daily in 50 patients. Group-2 was given salbutamol metered dose inhalational therapy 100mcg thrice daily in 30 patients. Results: Symptomatic improvement was observed in l two groups. At end point, mean FEV1 in tiotropium bromide treatment group improved by 149.96% compared with 135.16% salbutamol treatment group. At end point, mean FVC value in tiotropium bromide treatment group improved by 145.71% compared with 122.34% in salbutamol group. Mean FEV 1 / FVC also improved by 155.41% in tiotropium bromide group compared with 105.41 % in salbutamol group. Conclusion:The present study proved tiotropium provide superior safety and efficacy relative to control drug in bronchial asthma patients in both clinical assessment score and spirometrically.