Asthma exacerbations and worsenings in patients aged 1–75 years with add-on tiotropium treatment

Abstract

This review explores the effect of tiotropium Respimat® add-on therapy on asthma exacerbations and worsenings, adverse events (AEs) related to exacerbations and symptoms and any effects on seasonality across the 10 UniTinA-asthma® clinical trials comprising over 6000 patients. When added on to inhaled corticosteroids ± additional therapies, tiotropium significantly reduced the risk of exacerbations and worsenings in adults with symptomatic severe asthma and provided a non-significant improvement in worsenings in adults with symptomatic moderate and mild asthma, which was significant for patients with moderate asthma receiving tiotropium 2.5 µg once daily vs. placebo. Trials in paediatric patients were not powered to assess exacerbations or worsenings, but when AEs related to asthma exacerbations and symptoms were grouped into a composite endpoint and pooled, tiotropium improved outcomes vs. placebo (rate ratio 0.76; 95% confidence interval 0.63, 0.93). The reduction in exacerbations with tiotropium is apparent across all patients during the observed seasonal peaks of these events.

Bronchoscopic Targeted Lung Denervation in Patients with Severe Asthma: Preliminary Findings

“…Known complications are a bronchoscopicinduced COPD exacerbation and gastrointestinal symptoms in the post-procedural period [4]. LAMA as a potential add-on asthma treatment, especially for severe asthma patients, has gained interest in the past decade, showing benefits in reducing the need for rescue oral steroids and exacerbation risk [16][17][18]. With a similar mechanism of action and the results in COPD patients so far, TLD could also have potential in severe asthma patients.…”

Symptom control in patients with asthma using inhaled corticosteroids/long-acting β2-agonists (fluticasone furoate/vilanterol or budesonide/formoterol) in the US: a retrospective matched cohort study

“…Good control of asthma can be achieved in most patients (3) through the assessment of triggering factors, medication adherence, and establishing the appropriate level of treatment for each patient (2). Despite these strategies, some patients with asthma continue to experience persistent symptoms and exacerbations (2,4,5). Poorly controlled asthma is associated with increased use of rescue medication, accelerated pulmonary function loss, increased risk of exacerbations, healthcare resource utilization (HRU), and healthcare costs (2)(3)(4)(5)(6)(7)(8)(9).…”

“…Despite these strategies, some patients with asthma continue to experience persistent symptoms and exacerbations (2,4,5). Poorly controlled asthma is associated with increased use of rescue medication, accelerated pulmonary function loss, increased risk of exacerbations, healthcare resource utilization (HRU), and healthcare costs (2)(3)(4)(5)(6)(7)(8)(9). From a patient perspective, poor asthma control is associated with significant patient and caregiver burden and may translate into functional limitations, reduced quality of life (QoL), and loss of productivity (2,4,5,10).…”

“…Asthma symptoms and airflow limitation associated with poor control can fluctuate; however, they can represent a negative and impactful experience for the patient and can be life threatening (2,5). Although there is currently no global consensus on the definition, exacerbations are widely defined as an acute change in the patient's usual asthma status that requires an urgent change in the patient's treatment regimen (2,10); they are characterized by a progressive increase in symptoms, including breathlessness, chest tightness, or wheezing, and an acute decline in lung function (2).…”