Tiotropium improves lung function in patients with severe uncontrolled asthma: A randomized controlled trial

Kerstjens, Huib A. M.; Disse, Bernd; Schröder-Babo, W; Bantje, Theo A.; Gahlemann, Martina; Sigmund, Ralf; Engel, Michael; Noord, J.A. van

doi:10.1016/j.jaci.2011.04.039

Cited by 253 publications

(240 citation statements)

References 25 publications

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“…Tiotropium bromide improved lung function and symptoms in moderate-to-severe asthma patients not controlled on moderate-to high-dose ICSs with or without LABAs [219,220]. In patients taking high doses of ICSs and LABAs, the addition of tiotropium bromide provided improvements in FEV1, reduced asneeded use of SABAs and modestly reduced the risk of a severe exacerbation [219,221].…”

Section: Long-acting Muscarinic Antagonistsmentioning

confidence: 96%

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International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma

et al. 2013

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Severe or therapy-resistant asthma is increasingly recognised as a major unmet need. A Task Force, supported by the European Respiratory Society and American Thoracic Society, reviewed the definition and provided recommendations and guidelines on the evaluation and treatment of severe asthma in children and adults.A literature review was performed, followed by discussion by an expert committee according to the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach for development of specific clinical recommendations.When the diagnosis of asthma is confirmed and comorbidities addressed, severe asthma is defined as asthma that requires treatment with high dose inhaled corticosteroids plus a second controller and/or systemic corticosteroids to prevent it from becoming “uncontrolled” or that remains “uncontrolled” despite this therapy. Severe asthma is a heterogeneous condition consisting of phenotypes such as eosinophilic asthma. Specific recommendations on the use of sputum eosinophil count and exhaled nitric oxide to guide therapy, as well as treatment with anti-IgE antibody, methotrexate, macrolide antibiotics, antifungal agents and bronchial thermoplasty are provided.Coordinated research efforts for improved phenotyping will provide safe and effective biomarker-driven approaches to severe asthma therapy.

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Section: Long-acting Muscarinic Antagonistsmentioning

confidence: 96%

“…In patients taking high doses of ICSs and LABAs, the addition of tiotropium bromide provided improvements in FEV1, reduced asneeded use of SABAs and modestly reduced the risk of a severe exacerbation [219,221]. There have been no studies of tiotropium in children with asthma.…”

Section: Long-acting Muscarinic Antagonistsmentioning

confidence: 99%

International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma

et al. 2013

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“…This suggests that despite the good effects of tiotropium on lung function no significant effect on other clinical parameters was demonstrated. Only 2 studies by Kerstjens et al 16 reported data about exacerbations. Because the data currently available on exacerbations are insufficient for a meta-analysis, further investigation into the effects of tiotropium on exacerbations are required.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, Bateman et al 12 reported that tiotropium was not inferior to salmeterol in maintaining improved lung function in B16-Arg/Arg patients with asthma and that the addition of tiotropium to treatment with a high-dose inhaled corticosteroid plus a long-acting ␤ 2 agonist improved lung function in patients with poorly controlled severe asthma. 16 The aim of the present meta-analysis was to evaluate the efficacy and safety of tiotropium versus placebo in asthmatic patients whose symptoms were inadequately controlled with standard treatment regimens (ie, inhaled corticosteroids with or without long-acting ␤ 2 agonists).…”

Section: Introductionmentioning

confidence: 99%

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 long-acting anti-cholinergic agent tiotropium has been shown to be beneficial in patients with moderate-to-severe uncontrolled asthma with improvement of symptoms, pulmonary function [38,39], and time to first exacerbation [40]. However, increased mortality rates from cardiovascular causes have been reported in patients with chronic obstructive pulmonary disease who used tiotropium via a mist inhaler.…”

Section: Anti-cholinergic Agentsmentioning

confidence: 99%

Severe refractory asthma: an update

Wener

Bel

2013

European Respiratory Review

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Asthma is a heterogeneous disease in which adequate asthma control cannot be achieved in a substantial proportion despite currently available treatment possibilities. This subgroup has been defined as ''severe refractory'' asthma. Over the past years considerable progress has been made regarding a more exact definition of severe refractory asthma. A systematic approach to evaluate the asthma patient has been postulated. Further detailed classification into distinct phenotypes is ongoing to target the right treatment to the right patient. And, new therapeutic targeted treatment options are currently in development to provide possible new targets to improve disease state, symptoms and quality of life. This review will provide an update on the latest advancements with regard to all these domains. @ERSpublications Phenotyping the severe asthma patient is essential to ensure the right treatment is given to the right patient

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Tiotropium improves lung function in patients with severe uncontrolled asthma: A randomized controlled trial

Cited by 253 publications

References 25 publications

International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma

International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma

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

Severe refractory asthma: an update

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