Improvements with tiotropium in COPD patients with concomitant asthma

Magnussen, H; Bugnas, B; Noord, JA van; Schmidt, Peter; Gerken, Fronke; Kesten, Steven

doi:10.1016/j.rmed.2007.08.003

Cited by 116 publications

(67 citation statements)

References 22 publications

(25 reference statements)

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“…Thus far, the only placebo-controlled study in ACOS has shown that once daily tiotropium bromide significantly improved FEV 1 , peak expiratory flow rates and decreased use of rescue medication [Magnussen et al 2008]. So far, no further clinical studies on long-acting anticholinergics or β sympathomimetics have been performed.…”

Section: Long-acting Bronchodilatorsmentioning

confidence: 99%

Asthma and chronic obstructive pulmonary disease overlap: asthmatic chronic obstructive pulmonary disease or chronic obstructive asthma?

Slats

Taube

2015

Ther Adv Respir Dis

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Asthma and chronic obstructive pulmonary disease (COPD) are different disease entities. They are both clinical diagnoses, with diagnostic tools to discriminate between one another. However, especially in older patients (>55 years) it seems more difficult to differentiate between asthma and COPD. This has led to the definition of a new phenotype called asthma COPD overlap syndrome (ACOS). However, our understanding of ACOS is at a very preliminary stage, as most research has involved subjects with existing diagnoses of asthma or COPD from studies with different definitions for ACOS. This has led to different and sometimes opposing results between studies on several features of ACOS, also depending on the comparison with COPD alone, asthma alone or both, which are summarized in this review.We suggest not using the term ACOS for a patient with features of both asthma and COPD, but to describe a patient with chronic obstructive airway disease as completely as possible, with regard to characteristics that determine treatment response (e.g. eosinophilic inflammation) and prognosis (such as smoking status, exacerbation rate, fixed airflow limitation, hyperresponsiveness, comorbidities). This will provide a far more clinically relevant diagnosis, and would aid in research on treatment in more homogenous groups of patients with chronic airways obstruction. More research is certainly needed to develop more evidence-based definitions for this patient group and to evaluate biomarkers, which will help to further classify these patients, treat them more adequately and unravel the underlying pathophysiological mechanism.

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Section: Long-acting Bronchodilatorsmentioning

confidence: 99%

Asthma and chronic obstructive pulmonary disease overlap: asthmatic chronic obstructive pulmonary disease or chronic obstructive asthma?

Slats

Taube

2015

Ther Adv Respir Dis

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“…Another RCT was designed to determine the spirometric effects of tiotropium in COPD patients with concomitant asthma. 24 The results showed that the patients with COPD and concomitant asthma achieved spirometric improvements with tiotropium treatment along with symptomatic benefits as seen by a reduced need for rescue medication. To reduce the heterogeneity of different trials, we also selected only data from asthma patients without other lung diseases.…”

Section: Discussionmentioning

confidence: 96%

Tiotropium Versus Placebo for Inadequately Controlled Asthma: A Meta-Analysis

Tian¹,

Chen

Chen³

et al. 2013

Respir Care

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OBJECTIVE: This meta-analysis was performed to evaluate the efficacy and safety of the addition of tiotropium to standard treatment regimens for inadequately controlled asthma. METHODS: A systematic search was made of PubMed, EMBASE, MEDLINE, and CENTRAL databases, and ClinicalTrials.gov, and a hand search of leading respiratory journals. Randomized, double-blind clinical trials on the treatment of inadequately controlled asthma for > 4 weeks with the addition of tiotropium, compared with placebo, were reviewed. Studies were pooled to odds ratio (OR) and weighted mean differences (

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“…The only clinical trial performed to date in patients with ACOS studied the effects of tiotropium in 472 individuals with concomitant COPD and asthma. Improvements in lung function and a reduction in rescue medication were observed with tiotropium [35]. However, the main interest in differentiating ACOS from COPD lies in the different response to ICS.…”

Section: Treatmentmentioning

confidence: 99%

The asthma-COPD overlap syndrome: a new entity?

2015

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SummaryAsthma and COPD are the most frequent chronic respiratory diseases. Although they have different characteristics, some individuals share features of both diseases, which has been called the asthma-COPD overlap syndrome (ACOS). Although there is not a universally accepted definition for ACOS, it was initially defined as symptoms of increased variability of airflow in association with an incompletely reversible airflow obstruction. The most recent COPD guidelines include this phenotype and its diagnostic features. Patients with ACOS are usually characterized by increased reversibility of airflow obstruction, eosinophilic bronchial and systemic inflammation, and increased response to inhaled corticosteroids, compared with COPD patients. The relevance of the ACOS is the need to identify patients with COPD who may have underlying eosinophilic inflammation that responds better to inhaled corticosteroids. Until new diagnostic tools are developed, a previous diagnosis of asthma in a patient with COPD can be a reliable criterion to suspect ACOS in a patient with COPD but a comprehensive approach may be required in most cases for a definitive diagnosis of ACOS.

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Improvements with tiotropium in COPD patients with concomitant asthma

Abstract: Patients with COPD and concomitant asthma achieve spirometric improvements with tiotropium along with symptomatic benefit as seen by reduced need for rescue medication.

Cited by 116 publications

References 22 publications

Asthma and chronic obstructive pulmonary disease overlap: asthmatic chronic obstructive pulmonary disease or chronic obstructive asthma?

Asthma and chronic obstructive pulmonary disease overlap: asthmatic chronic obstructive pulmonary disease or chronic obstructive asthma?

Tiotropium Versus Placebo for Inadequately Controlled Asthma: A Meta-Analysis

The asthma-COPD overlap syndrome: a new entity?

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