Tiotropium improves lung function, exacerbation rate, and asthma control, independent of baseline characteristics including age, degree of airway obstruction, and allergic status

Kerstjens, Huib A. M.; Moroni-Zentgraf, Petra; Tashkin, Donald P.; Dahl, Ronald; Paggiaro, Pierluigi; Vandewalker, Mark; Schmidt, Hendrik; Engel, Michael; Bateman, Eric D.

doi:10.1016/j.rmed.2016.06.013

Cited by 91 publications

(78 citation statements)

References 30 publications

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“…Several large, high quality randomised controlled trials (one of which enrolled asthma patients with persistent post-bronchodilator airflow limitation 176 ) have consistently shown improvements in FEV 1 in patients with asthma, both in children and in adults, when tiotropium is added to inhaled corticosteroid and inhaled corticosteroid/LABA therapies. [176][177][178][179][180][181][182] Several studies have also shown a reduction in exacerbation risk, 179 183 as well as asthma symptom control. [179][180][181][182] Whether LAMA compounds other than tiotropium have similar positive effects is yet to be tested, but the clinical improvements observed in both COPD and asthma patients suggest that LAMA therapies may be an option for patients with ACOS.…”

Section: Possibilities For Therapeutic Interventionmentioning

confidence: 99%

“…[176][177][178][179][180][181][182] Several studies have also shown a reduction in exacerbation risk, 179 183 as well as asthma symptom control. [179][180][181][182] Whether LAMA compounds other than tiotropium have similar positive effects is yet to be tested, but the clinical improvements observed in both COPD and asthma patients suggest that LAMA therapies may be an option for patients with ACOS. cells triggers cytokine mediated eosinophilic inflammation; blockage of this linkage by compounds such as omalizumab helps to attenuate this cascade, which ultimately has been shown to reduce exacerbations, hospital admissions, emergency department visits, and inhaled corticosteroid and rescue inhaler use in patients with advanced asthma.…”

Section: Possibilities For Therapeutic Interventionmentioning

confidence: 99%

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Asthma-COPD overlap syndrome: pathogenesis, clinical features, and therapeutic targets

Leung

Sin

2017

BMJ

131

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Asthma-COPD overlap syndrome (ACOS) or asthma-COPD overlap captures the subset of patients with airways disease who have features of both asthma and chronic obstructive pulmonary disease (COPD). Although definitions of ACOS vary, it is generally thought to encompass persistent airflow limitation in a patient older than 40 years of age with either a history of asthma or large bronchodilator reversibility. ACOS affects about a quarter of patients with COPD and almost a third of patients who previously had asthma. Compared with their counterparts with asthma or COPD alone, patients with ACOS have significantly worse respiratory symptoms, poorer quality of life, and increased risk of exacerbations and hospital admissions. Whether this condition emerges after gradual shifts in airway remodelling and inflammation in a patient with COPD, as the result of noxious exposures in a patient with asthma, or even as a de novo disease with its own pathology is yet to be determined. Nevertheless, using treatments developed for asthma or COPD that target eosinophilic, neutrophilic, or paucigranulocytic airway inflammation may be a helpful approach to these patients until further clinical trials can be performed.

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Section: Possibilities For Therapeutic Interventionmentioning

confidence: 99%

Section: Possibilities For Therapeutic Interventionmentioning

confidence: 99%

Asthma-COPD overlap syndrome: pathogenesis, clinical features, and therapeutic targets

Leung

Sin

2017

BMJ

131

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“…Other second controllers include leukotriene receptor antagonists (LTRA) [108], tiotropium or theophylline, possibly in combination. The effect of adding in tiotropium is possibly better in ex-smokers than never-smokers [109]. For reliever treatment, short-acting beta-agonists or ICS in combination with formoterol are the two alternatives.…”

Section: Management Of Severe Asthmamentioning

confidence: 99%

Nordic consensus statement on the systematic assessment and management of possible severe asthma in adults

Porsbjerg

Ulrik

Skjold

et al. 2018

European Clinical Respiratory Journal

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Although a minority of asthma patients suffer from severe asthma, they represent a major clinical challenge in terms of poor symptom control despite high-dose treatment, risk of exacerbations, and side effects. Novel biological treatments may benefit patients with severe asthma, but are expensive, and are only effective in appropriately targeted patients. In some patients, symptoms are driven by other factors than asthma, and all patients with suspected severe asthma (‘difficult asthma’) should undergo systematic assessment, in order to differentiate between true severe asthma, and ‘difficult-to-treat’ patients, in whom poor control is related to factors such as poor adherence or co-morbidities. The Nordic Consensus Statement on severe asthma was developed by the Nordic Severe Asthma Network, consisting of members from Norway, Sweden, Finland, Denmark, Iceland and Estonia, including representatives from the respective national respiratory scientific societies with the aim to provide an overview and recommendations regarding the diagnosis, systematic assessment and management of severe asthma. Furthermore, the Consensus Statement proposes recommendations for the organization of severe asthma management in primary, secondary, and tertiary care.

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“…Time to the first severe exacerbation was increased in patients treated with add-on tiotropium (282 days vs. 226 days), with an overall reduction of 21% in the risk of a severe exacerbation (hazard ratio: 0.79; p = 0.03) [139]. The response to treatment with tiotropium was shown to be independent of baseline characteristics including gender, age, body mass index, disease duration, age at asthma onset, FEV 1 % predicted at screening and reversibility [140]. …”

Section: Introductionmentioning

confidence: 99%

The evidence on tiotropium bromide in asthma: from the rationale to the bedside

Radovanovic

Santus

Blasi

et al. 2017

Multidiscip Respir Med

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Severe and poorly controlled asthma still accounts for a great portion of the patients affected. Disease control and future risk management have been identified by international guidelines as the main goals in patients with asthma. The need for new treatment approaches has led to reconsider anticholinergic drugs as an option for asthma treatment. Tiotropium is the first anticholinergic drug that has been approved for children and adults with poorly controlled asthma and is currently considered as an option for steps 4 and 5 of the Global Initiative for Asthma. In large randomized clinical trials enrolling patients with moderate to severe asthma, add-on therapy with tiotropium has demonstrated to be efficacious in improving lung function, decreasing risk of exacerbation and slowing the worsening of disease; accordingly, tiotropium demonstrated to be non inferior compared to long acting beta-agonists in the maintenance treatment along with medium to high inhaled corticosteroids. In view of the numerous ancillary effects acting on inflammation, airway remodeling, mucus production and cough reflex, along with the good safety profile and the broad spectrum of efficacy demonstrated in different disease phenotypes, tiotropium can represent a beneficial alternative in the therapeutic management of poorly controlled asthma. The present extensive narrative review presents the pharmacological and pathophysiological basis that guided the rationale for the introduction of tiotropium in asthma treatment algorithm, with a particular focus on its conventional and unconventional effects; finally, data on tiotropium efficacy and safety. from recent randomized clinical trials performed in all age categories will be extensively discussed.

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Tiotropium improves lung function, exacerbation rate, and asthma control, independent of baseline characteristics including age, degree of airway obstruction, and allergic status

Abstract: ClinicalTrials.gov; numbers NCT00772538 and NCT00776984 URL: www.clinicaltrials.gov.

Cited by 91 publications

References 30 publications

Asthma-COPD overlap syndrome: pathogenesis, clinical features, and therapeutic targets

Asthma-COPD overlap syndrome: pathogenesis, clinical features, and therapeutic targets

Nordic consensus statement on the systematic assessment and management of possible severe asthma in adults

The evidence on tiotropium bromide in asthma: from the rationale to the bedside

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