title: Long-acting anticholinergic agents in patients with uncontrolled asthma: a systematic review and meta-analysis.
abstract: METHODS
  A novel effective treatment is necessary for severe asthma.
  
  
  OBJECTIVE
  To review clinical trials examining the role of tiotropium in patients with poorly controlled asthma despite inhaled corticosteroid use with or without long-acting β₂-agonists.
  
  
  METHODS
  A computerised search of electronic databases (Medline, EMBASE and Cochrane Central Register) was performed. Randomised controlled trials of at least a 4-week treatment duration with findings published in English were included.
  
  
  RESULTS
  Five studies involving 1635 patients were analysed. Compared with a placebo or a double dose of inhaled corticosteroids, the addition of tiotropium increased mean trough and peak forced expiratory volume in 1 second by 97 ml (95%CI 71-122) and 103 ml (95%CI 42-163), respectively. The mean differences in morning peak expiratory flow were 19.2 l/min (95%CI 11.8-26.6). Tiotropium also reduced the risk of severe acute exacerbation (OR 0.73, 95%CI 0.56-0.96) and improved Asthma Quality-of-Life Questionnaire score significantly by 0.10 (95%CI 0.04-0.16). There were no differences in serious adverse events.
  
  
  CONCLUSIONS
  The addition of tiotropium may be beneficial for patients with poorly controlled asthma, although exacerbation or safety issues should be clarified in long-term trials before its wide use in asthma.
authors.affiliation: Department of Pulmonary and Critical Care Medicine, and Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: S W
authors.initials: SW
authors.lastname: Lee
authors.affiliation: Institute for Evidence-based Medicine, Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Korea.
authors.forename: H J
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea.
authors.forename: K H
authors.initials: KH
authors.lastname: Yoo
authors.affiliation: Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea.
authors.forename: Y B
authors.initials: YB
authors.lastname: Park
authors.affiliation: Department of Pulmonology and Critical Care Medicine, Won Kwang University Sanbon Hospital, Sanbon, Korea.
authors.forename: J-Y
authors.initials: JY
authors.lastname: Park
authors.affiliation: Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University, College of Medicine, Seoul, Korea.
authors.forename: J Y
authors.initials: JY
authors.lastname: Jung
authors.affiliation: Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.
authors.forename: J-Y
authors.initials: JY
authors.lastname: Moon
authors.affiliation: Division of Pulmonology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: M K
authors.initials: MK
authors.lastname: Byun
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Ewha Medical Center and Ewha Medical Research Institute, Ewha Womans University, School of Medicine, Mokdong Hospital, Seoul, Korea.
authors.forename: S W
authors.initials: SW
authors.lastname: Kim
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, Korea.
authors.forename: Y H
authors.initials: YH
authors.lastname: Kim
mesh_terms: D018927:Anti-Asthmatic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001249:Asthma / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D001993:Bronchodilator Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D018680:Cholinergic Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005541:Forced Expiratory Volume; D006801:Humans; D008168:Lung / Q000187:drug effects* / Q000503:physiopathology; D016017:Odds Ratio; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D012602:Scopolamine Derivatives / Q000009:adverse effects / Q000627:therapeutic use*; D012720:Severity of Illness Index; D000069447:Tiotropium Bromide; D016896:Treatment Outcome
chemical_list: D018927:Anti-Asthmatic Agents; D001993:Bronchodilator Agents; D018680:Cholinergic Antagonists; D012602:Scopolamine Derivatives; D000069447:Tiotropium Bromide