<p>Barriers to achieving asthma control in adults: evidence for the role of tiotropium in current management strategies</p>

Abstract

Despite the availability of a range of treatment options and management guidelines, a high proportion of adults with asthma remain uncontrolled. The challenge of managing uncontrolled asthma includes providing efficacious treatment while limiting side effects, recognizing situations when a change in asthma therapy is required, and considering patient preferences and satisfaction. In line with the Global Initiative for Asthma report, asthma management is based on a backbone of inhaled corticosteroid (ICS) therapy and use of add-on therapies to achieve disease control. This review considers whether add-on options could be better utilized in clinical practice. A number of long-acting muscarinic antagonists are in development, but tiotropium is the most widely studied for use in asthma. Evidence demonstrating the efficacy of tiotropium as an add-on therapy to at least ICS in adults with symptomatic mild, moderate, and severe asthma is presented from randomized controlled trials and real-world evidence. In addition, the benefit of tiotropium therapy in a wide range of patient phenotypes and disease severities without the need for biomarker assessment is discussed. Additional strategies that complement this approach, such as recognizing and overcoming barriers to adherence, ensuring optimal device use, and education and support to enhance patient–physician communication, are discussed. Physician education can also help raise awareness that additional management options are available for patients with moderate-to-severe asthma who remain uncontrolled on ICS/long-acting β2-agonist treatment.

Clinical predictors of treatment response to tiotropium add-on therapy in adult asthmatic patients: From multicenter real-world cohort data in Korea

“…Among LAMAs, tiotropium has been used most widely and for a long time. 25 Tiotropium RespimatÒ is approved in asthmatic patients aged 6 years and older in Korea, the United States, and the European Union. 25,26 Several studies have elucidated the efficacy of tiotropium in asthma.…”

“…25 Tiotropium RespimatÒ is approved in asthmatic patients aged 6 years and older in Korea, the United States, and the European Union. 25,26 Several studies have elucidated the efficacy of tiotropium in asthma. A double-blind, three-way, crossover trial, called the Tiotropium Bromide as an Alternative to Increased Inhaled Glucocorticoid in Patients Inadequately Controlled on a Lower Dose of Inhaled Corticosteroid (TALC) study, revealed that adding tiotropium is superior to increasing ICS dose in patients whose asthma symptoms are not controlled by inhaled beclomethasone alone at a dose of 160 mg/day, and non-inferior to adding salmeterol with respect to morning and evening peak expiratory flow (PEF) and asthma symptom score.…”

Exploring the influence of the microbiome on the pharmacology of anti-asthmatic drugs

“…Moreover, we still do not understand why these subsets of people do not respond to corticosteroids (Henderson et al 2020 ). Many theories have been suggested ranging from genetics to patient non-adherence (Jenkins 2019 ), but could the lung microbiome have a role to play (Barcik et al 2020 )? Barcik and colleagues in 2020 discussed the connection between the gut and lung and how the microbiota plays a bidirectional interaction between the two sites.…”

Association between asthma control and healthcare costs: Results from a German linked data study

“…2,5 And yet, despite the availability of a wide range of treatment options, a large body of research has indicated that effective implementation of clinical guidelines is lacking, corresponding with steady, high rates of uncontrolled asthma. 6,7 Within the literature, asthma control refers to the severity of symptoms and risk of poor outcomes experienced by a patient, despite use of a prescribed therapy. 5 Asthma is classified as uncontrolled when it involves poor symptom control (i.e.…”

“…2,5 And yet, despite the availability of a wide range of treatment options, a large body of research has indicated that effective implementation of clinical guidelines is lacking, corresponding with steady, high rates of uncontrolled asthma. 6,7…”