Tiotropium may improve asthma symptoms and lung function in asthmatic patients with irreversible airway obstruction: the real‐life data

Abadoğlu, Öznur; Berk, Serdar

doi:10.1111/crj.12230

Cited by 24 publications

(18 citation statements)

References 29 publications

(36 reference statements)

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“…An analysis of 64 patients with poor disease control despite treatment with high dose ICS/LABA showed that the introduction of tiotropium as add on therapy improved asthma control in 42.2% of cases, decreasing the number of emergency department visits and hospitalizations in 46.9% and 50.0% of cases, respectively [149]. A larger cohort involving 2,042 outpatients from United Kingdom compared the number of exacerbations (emergency visits, hospitalizations and oral corticosteroids use) and acute asthma events (antibiotic use for lower respiratory tract infections) in the year before and in the year following the prescription of tiotropium.…”

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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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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“…Later studies have confirmed that treatment with anticholinergics as an add-on to ICS or ICS+LABA improves lung function and reduces the number of exacerbations, emergency room visits, and hospitalisations (66, 67). …”

Section: Indicator 3: Long-acting Beta-agonist Use Without Concomitanmentioning

confidence: 95%

The Danish National Database for Asthma: establishing clinical quality indicators

Hansen

Hoffmann-Petersen

Sverrild

et al. 2016

European Clinical Respiratory Journal

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Asthma is one of the most common chronic diseases worldwide affecting more than 300 million people. Symptoms are often non-specific and include coughing, wheezing, chest tightness, and shortness of breath. Asthma may be highly variable within the same individual over time. Although asthma results in death only in extreme cases, the disease is associated with significant morbidity, reduced quality of life, increased absenteeism, and large costs for society. Asthma can be diagnosed based on report of characteristic symptoms and/or the use of several different diagnostic tests. However, there is currently no gold standard for making a diagnosis, and some degree of misclassification and inter-observer variation can be expected. This may lead to local and regional differences in the treatment, monitoring, and follow-up of the patients. The Danish National Database for Asthma (DNDA) is slated to be established with the overall aim of collecting data on all patients treated for asthma in Denmark and systematically monitoring the treatment quality and disease management in both primary and secondary care facilities across the country. The DNDA links information from population-based disease registers in Denmark, including the National Patient Register, the National Prescription Registry, and the National Health Insurance Services register, and potentially includes all asthma patients in Denmark. The following quality indicators have been selected to monitor trends: first, conduction of annual asthma control visits, appropriate pharmacological treatment, measurement of lung function, and asthma challenge testing; second, tools used for diagnosis in new cases; and third, annual assessment of smoking status, height, and weight measurements, and the proportion of patients with acute hospital treatment. The DNDA will be launched in 2016 and will initially include patients treated in secondary care facilities in Denmark. In the nearby future, the database aims to include asthma diagnosis codes and clinical data registered by general practitioners and specialised practitioners as well.

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“…Findings showed that primary care physicians in the UK have been prescribing long-acting anticholinergics for the treatment of asthma since 2002, predominantly as an add-on therapy in older patients with poorly controlled asthma despite good treatment compliance, particularly in those who are current or former smokers [63]. Similarly, in a second retrospective study of real-life data from 64 patients with severe asthma in Turkey, tiotropium add-on to high-dose ICS plus LABA therapy was found to significantly improve the percentage of patients with uncontrolled asthma, the number of emergency department visits, the number of hospitalisations and lung function, in addition to significant decreases in ICS dose, oral corticosteroid use and antibiotics for upper respiratory tract disease [64]. Both studies were well designed, with results consistent with those from randomised clinical trials of tiotropium in asthma.…”

Section: Tiotropium Add-on Therapy Delivered Via the Respimat Soft MImentioning

confidence: 98%

Long-acting muscarinic antagonists: a potential add-on therapy in the treatment of asthma?

et al. 2016

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Asthma is a chronic inflammatory disorder of the airways that is a major global burden on both individuals and healthcare systems. Despite guideline-directed treatment, a significant proportion of patients with asthma do not achieve control. This review focuses on the potential use of long-acting anticholinergics as bronchodilators in the treatment of asthma, with results published from clinical trials of glycopyrrolate, umeclidinium and tiotropium. The tiotropium clinical trial programme is the most advanced, with data available from a number of phase II and III studies of tiotropium as an add-on to inhaled corticosteroid maintenance therapy, with or without a long-acting β 2 -agonist, in patients across asthma severities. Recent studies using the Respimat Soft Mist inhaler have identified 5 µg once daily as the preferred dosing regimen, which has shown promising results in adults, adolescents and children with asthma. Tiotropium Respimat has recently been incorporated into the Global Initiative for Asthma 2015 treatment strategy as a recommended alternative therapy at steps 4 and 5 in adult patients with a history of exacerbations. The increasing availability of evidence from ongoing and future clinical trials will be beneficial in determining where long-acting anticholinergic agents fit in future treatment guidelines across a variety of patient populations and disease severities. @ERSpublications Anticholinergics as an add-on to current treatment options may address the current unmet need in asthma management http://ow.ly/TTi1E

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Tiotropium may improve asthma symptoms and lung function in asthmatic patients with irreversible airway obstruction: the real‐life data

Abstract: Our study has suggested that, for patients with poorly controlled asthma despite of the use of ICS/LABA, the addition of tiotropium to standard care may be beneficial.

Cited by 24 publications

References 29 publications

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

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

The Danish National Database for Asthma: establishing clinical quality indicators

Long-acting muscarinic antagonists: a potential add-on therapy in the treatment of asthma?

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