Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2014 Feb 27:7:11-21.
doi: 10.2147/JAA.S38841. eCollection 2014.

Tiotropium in asthma: a systematic review

Elizabeth Befekadu  1 , Claudia Onofrei  1 , Gene L Colice  2
Affiliations
Review

Tiotropium in asthma: a systematic review

Elizabeth Befekadu et al. J Asthma Allergy. .

Abstract

Introduction: The objective of this paper is to systematically review the existing evidence of the effectiveness and safety profile of a long-acting inhaled muscarinic antagonist as add-on therapy in patients with asthma that is uncontrolled despite inhaled corticosteroid (ICS) use.

Methods: With the assistance of two experienced research librarians, we searched Ovid MEDLINE/PubMed (1946 to September 12, 2013), the Cochrane Library review, and the TRIP database. The key search terms were "tiotropium and asthma." The search was limited to human data published in English. Included in the systematic review were all randomized controlled trials that evaluated the efficacy of tiotropium in patients with asthma. The clinical trials had to be at least 4 weeks in duration and to provide adequate information on clinically appropriate end points in asthma care (eg, change in lung function, exacerbation rates, and/or ICS dosing). Data on patient characteristics, study design, outcome measures, concomitant asthma medication, and adverse events were extracted from the full text of each included individual study. Marked heterogeneity of study design precluded statistical pooling of results for a meta-analysis. Consequently, only descriptive summaries of outcomes are provided.

Results: Our database search retrieved 149 citations. We found five randomized controlled trials in humans that met our criteria for inclusion in the systematic review. We also found two open-label uncontrolled trials that were considered in the discussion. Each of the five included studies met the Consolidated Standards of Reporting Trials criteria for a well-designed randomized trial.

Discussion: The five clinical studies included in this systematic review focused on evaluating the efficacy of tiotropium as add-on therapy to ICS or ICS in combination with a long-acting inhaled β2-agonist (LABA) in patients with uncontrolled moderate to severe persistent asthma. Tiotropium maintained lung function when ICSs were tapered and when an LABA was discontinued. Tiotropium improved lung function when added to ICS alone or ICS-LABA combination therapy. In the only trial to have compared the addition of tiotropium with doubling the dose of ICS, tiotropium provided significantly superior results. In trials in which the addition of tiotropium was compared with salmeterol, the beneficial effects of these two bronchodilators were similar. No safety concerns were found with use of tiotropium as add-on therapy.

Conclusion: Tiotropium may have a beneficial role in moderate to severe persistent asthma despite use of an ICS or ICS and LABA. Use of tiotropium as add-on therapy poses no safety concerns.

Keywords: LABA; LAMA; asthma; inflammation; inhaled corticosteroid; lung; tiotropium.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Selection process of citations. Abbreviation: COPD, chronic obstructive pulmonary disease.
See this image and copyright information in PMC

References

    1. Fanta CH. Asthma. N Eng J Med. 2009;360:1002–1014. - PubMed
    1. Akinbami LJ, Moorman JE, Bailey C, et al. Trends in Asthma Prevalence, Health Care Use, and Mortality in the United States, 2001–2010. [Accessed January 16, 2014]. Available from: http://www.cdc.gov/nchs/data/databriefs/db94.htm.
    1. National Asthma Education and Prevention Program . Guidelines for the Diagnosis and Management of Asthma (EPR-3) Bethesda, MD: National Heart, Lung, and Blood Institute; 2007. [Accessed January 16, 2014]. Expert Panel Report III. NIH publication No 08-4051. Available from: http://www.nhlbi.nih.gov/guidelines/asthma/
    1. Global Initiative for Asthma Global Strategy for Asthma Management and Prevention. 2012. [Accessed January 16, 2014]. Update. Available from: http://www.ginasthma.org/documents/4.
    1. Olivieri D, Chetta A, Del Donno M, et al. Effect of short-term treatment with low-dose inhaled fluticasone propionate on airway inflammation and remodeling in mild asthma. Am J Respir Crit Care Med. 1997;155:1864–1871. - PubMed

LinkOut - more resources