Tiotropium add-on to inhaled corticosteroids versus addition of long-acting β2-agonists for adults with asthma

Abstract

Additional management options, and better use of current options, are needed to help support a large proportion of patients with asthma whose symptoms remain uncontrolled on inhaled corticosteroids (ICS). Here, we aim to review the safety and efficacy of adding tiotropium to ICS compared with adding a long-acting β-agonist (LABA) for adults whose asthma is not well controlled on ICS alone. Adding tiotropium to a background of ICS provides beneficial effects that are comparable with addition of a LABA in terms of lung function measures, exacerbations, asthma control and other endpoints. In addition, tiotropium and LABAs are both well tolerated. Some patients respond to either tiotropium or LABA treatment, but not both, suggesting that there are groups of patients that may respond better to one of these drugs. Currently, tiotropium is recommended as an add-on therapy in patients with severe asthma (Global Initiative for Asthma Steps 4 and 5) whose asthma is uncontrolled despite treatment with ICS/LABA. Tiotropium is also effective in patients with less severe disease and may benefit patients who experience adverse events from LABA treatment or where LABAs are ineffective. Tiotropium is therefore an important therapeutic option in asthma, not only as recommended as an add-on treatment with ICS/LABA, but also as an alternative to the addition of LABA to maintenance therapy with an ICS.

Burden of Asthma and Role of 2.5 µg Tiotropium Respimat® as an Add-On Therapy: A Systematic Review of Phase 2/3 Trials

“…Improvements in peak and trough FEV 1 were observed with 2.5 µg tiotropium Respimat ® compared with placebo in the majority of studies [16–18, 20, 21, 27, 29]. Although the minimal clinically important difference for FEV 1 responses in patients with asthma is not well defined, the observed effect sizes in this analysis were comparable to those observed with the addition of LABA to ICS therapy [20, 30–32]. Our findings show that 2.5 µg tiotropium Respimat ® improved FVC in patients with moderate asthma (adults and children aged 6–11 years), providing a good measure of potential effects of tiotropium on small-airway dysfunction [33].…”

Essential Role of Pharmacists in Asthma Care and Management

“…14 Furthermore, the use of a LAMA, either in addition to LABA + ICS or as an alternative to a LABA added to ICS maintenance therapy, may be needed as add-on treatment in patients whose asthma is not well controlled on ICS and LABA. 15,16 Of note, patients with severe asthma are good candidates for treatment with anti-inflammatory therapies, including newer biologic agents that target T-helper type 2 (Th2)–driven inflammatory pathways, because Th2-type inflammation is more common in these patients. 17 Add-on therapy with immunomodulators, used in specific asthma populations having a severe asthma phenotype, has been shown to reduce exacerbations 18,19 and hospitalizations.…”

Add-on Tiotropium in Chinese Patients With Moderate Asthma: A Pooled Subgroup Analysis of MezzoTinA-Asthma 1 and 2

“…Subsequent reviews of tiotropium outcome trials demonstrated positive evidence for the benefits of tiotropium use in asthma across adults, children, and patients with heterogeneous asthma (phenotypes and endotypes) profiles 1415. For step 5 treatment, tiotropium has been shown to be beneficial16 and more cost-effective 14. Overall, tiotropium may be a preferred choice considering that the newer biologics therapy, that is, anti-IgE or anti-IL5, are less affordable in China in light of the lower economic status.…”