Is Tiotropium Appropriate For Uncontrolled Asthma?

Citation:  Kerstjens HAM, Engel M, Dahl R et. al. Tiotropium in Asthma Poorly Controlled with Standard Combination Therapy.  N Engl J Med 2012; 367:1198-1207.

Moderator: Roshni Patel, Pharm.D., PGY2 Ambulatory Care Pharmacy Resident

Panelists:  Mona Tsoukleris, Pharm.D. and Dennis Williams, Pharm.D.

Category: Ambulatory Care

Commentary Written By: Livia Macedo, PharmD

I read about the study discussion posted on Feb 18 by Dr. Patel “Tiotropium in asthma poorly controlled with standard combination therapy”.  This study was a two replicate randomized, double-blind, placebo-controlled trial which included patients (N=912) of age 18-75 years with asthma for >5 years diagnosed before age 40, lifelong nonsmokers or people who had a smoking history of fewer than 10 pack years with no smoking in the year before enrollment.  They excluded patients with COPD, serious coexisting illness, and concurrent use of anticholinergic bronchodilators. The study compared the effect on lung function and exacerbations of adding tiotropium 5 mcg or placebo, both delivered by a soft-mist inhaler once daily for 48 weeks. The results of this study showed that the addition of tiotropium to ICS and LABA therapy reduced the risk for exacerbations and improved lung function.  However the study presented with some limitations. Patients included in this study could have mixed asthma and COPD. To ensure these patients had solely asthma, they should have included patients from a different age group of 18-35 instead. In addition, this study was sponsored by the product’s manufacturer, which could have led to study bias. This agent may be a therapeutic option for patients with mixed asthma and COPD.  I think more research is needed at this time to determine whether this agent is a treatment option for patients solely with asthma. What are your thoughts? When would you consider the use of tiotropium?

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