Tiotropium step-up therapy for adults with uncontrolled asthma

January 01, 0001

Tiotropium step-up therapy for adults with uncontrolled asthma

These US investigators conducted a three-way, double-blind, triple-dummy crossover trial involving 210 adult patients with asthma. They evaluated the addition of tiotropium bromide (a long-acting anticholinergic agent approved for the treatment of chronic obstructive pulmonary disease but not asthma) to an inhaled glucocorticoid, as compared with a doubling of the dose of the inhaled glucocorticoid (primary superiority comparison) or the addition of the LABA salmeterol (secondary noninferiority comparison).

They found: "The use of tiotropium resulted in a superior primary outcome, as compared with a doubling of the dose of an inhaled glucocorticoid, as assessed by measuring the morning peak expiratory flow (PEF), with a mean difference of 25.8 liters per minute and superiority in most secondary outcomes, including evening PEF, with a difference of 35.3 liters per minute; the proportion of asthma-control days, with a difference of 0.079; the forced expiratory volume in 1 second (FEV1) before bronchodilation, with a difference of 0.10 liters; and daily symptom scores, with a difference of -0.11 points. The addition of tiotropium was also noninferior to the addition of salmeterol for all assessed outcomes and increased the prebronchodilator FEV1 more than did salmeterol, with a difference of 0.11 liters."

The authors concluded: "When added to an inhaled glucocorticoid, tiotropium improved symptoms and lung function in patients with inadequately controlled asthma. Its effects appeared to be equivalent to those with the addition of salmeterol."

Assessment of further patient-oriented outcomes such as risk of hospitalization and death are needed.

For the full abstract, click here.

N Engl J Med 363:1715-1726, 28 October 2010
© 2010 to the Massachusetts Medical Society
Tiotropium Bromide Step-Up Therapy for Adults with Uncontrolled Asthma. Stephen P. Peters, Susan J. Kunselman, Nikolina Icitovic, et al. Correspondence to Dr. Peters: [email protected]

Category: R. Respiratory. Keywords: asthma, adults, tiotropium, inhaled glucocorticoid, long acting beta-agonist, randomized controlled trial, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 16 November 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.