Can a better patient phenotyping predict the efficacy of tiotropium in asthmatic adolescents?

Reply to ‘Can a better patient phenotyping predict the efficacy of tiotropium in asthmatic adolescents?’

“…To the editor, We thank Liccardi et al [1] for their intriguing letter concerning our article [2]. They raise several points of interest regarding our report, which we will discuss here.…”

“…Finally, Liccardi et al [1] suggest that the 'limited statistical significance' achieved may be due to insufficient phenotyping and enrolment of non-responders. We maintain that there are numerical and statistically significant improvements in peak and trough forced expiratory volume in 1 s with tiotropium Respimat® across the studies in the endpoints required by the regulatory authorities for this study.…”

Can placebo challenge test (inducing a “nocebo effect”) be a suitable model to assess stress-induced bronchial obstruction? Suggestions from the multidisciplinary Working Groups “Stress-Asthma” and “AAIITO Regione Campania”

“…(11). The vagal hyperactivity induced by anxiety and stress in asthmatics also represents the basis of important considerations by a therapeutic point of view, such as the use of anticholinergic agents (12,13). Suggestions from "Asthma-Stress" and "AAIITO Regione Campania" Working Groups Since organizing bloody films vision could be of difficult feasibility in outpatient settings, the use of placebo administration has the advantage of exploiting the patient's inherent fear of taking drugs and the ambient situation that simulates taking an "active" drug thus inducing a stress status.…”

Anxiety and asthma in youth. Is a stress‐induced increased cholinergic tone the possible link?

“…Although the tolerability and efficacy of anticholinergic agents (especially long‐acting muscarinic antagonists [LAMAs]) have been investigated in adolescents suffering from asthma, we believe that LAMAs could be more useful in those patients characterized by increased cholinergic activity. Considering this background, we suggest also the necessity of an adequate phenotyping of asthmatic adolescents who could benefit from the use of tiotropium or ipratropium through the evaluation of basal cholinergic tone . O 2 inhalation, neck suction, slow deep breathing, metacholine inhalation, multiple frequency forced oscillation technique (FOT), measurement of resting heart rate and pupillometry constitute the most efficacious methods for evaluation of the degree of vagal tone.…”

“…Considering this background, we suggest also the necessity of an adequate phenotyping of asthmatic adolescents who could benefit from the use of tiotropium or ipratropium through the evaluation of basal cholinergic tone. 5 Adequate educational programs should be planned for all asthmatic patients suffering from psychological disorders. This approach requires a particular attention in youth in order to obtain a better control of respiratory symptoms and a possible delay in asthma progression and remodeling in the future.…”