title: Tiotropium bromide as add-on therapy to inhaled corticosteroids for treating asthma.
abstract: BACKGROUND
  Bronchial asthma is becoming increasingly prevalent worldwide. Although first-line therapy with inhaled corticosteroids (ICS) with or without long-acting β2 agonists (LABA) has significantly improved the clinical outcomes of asthma, they cannot provide all asthmatics with good control and thus alternatives or add-on drugs are required. Tiotropium is a long-acting muscarinic antagonist that has been used to treat chronic obstructive pulmonary disease and it has been approved for treating asthma in some countries. This agent has similar bronchodilatory effects to those of LABA and might also have anti-inflammatory and anti-remodeling effects.
  
  
  METHODS
  Some pivotal clinical trials have found tiotropium effective as an add-on medication for low-to-medium doses of ICS for treating symptomatic asthma and asthma that remains uncontrolled despite ICS plus LABA therapy.
  
  
  CONCLUSIONS
  Whether or not tiotropium has anti-inflammatory and anti-remodeling effects in humans with asthma is an important issue. Predictors that would identify patients who would derive the maximal potential benefit from treatment with tiotropium in addition to their current therapy are also needed. Although the cardiovascular toxicity of tiotropium is less remarkable in asthma than in chronic obstructive pulmonary disease, longer and larger studies are still needed to confirm the safety of tiotropium for treating asthma.
authors.affiliation: Toho University Ohashi Medical Center, Division of Respirology, Department of Internal Medicine , 2-17-6 Ohashi Meguro-ku, Tokyo 153-8515 , Japan +81 3 3468 1251 ; +81 3 3468 5082 ; hiroto.matsuse@med.toho-u.ac.jp.
authors.forename: Hiroto
authors.initials: H
authors.lastname: Matsuse
authors.forename: Tohru
authors.initials: T
authors.lastname: Yamagishi
authors.forename: Norio
authors.initials: N
authors.lastname: Kodaka
authors.forename: Atsuo
authors.initials: A
authors.lastname: Miura
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Kurose
authors.forename: Chihiro
authors.initials: C
authors.lastname: Nakano
authors.forename: Takeshi
authors.initials: T
authors.lastname: Oshio
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D018927:Anti-Asthmatic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001249:Asthma / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D002986:Clinical Trials as Topic; D004359:Drug Therapy, Combination; D006801:Humans; D018727:Muscarinic Antagonists / Q000494:pharmacology / Q000627:therapeutic use*; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000188:drug therapy; D012602:Scopolamine Derivatives / Q000494:pharmacology / Q000627:therapeutic use*; D000069447:Tiotropium Bromide
chemical_list: D000305:Adrenal Cortex Hormones; D018927:Anti-Asthmatic Agents; D018727:Muscarinic Antagonists; D012602:Scopolamine Derivatives; D000069447:Tiotropium Bromide
keywords: airway hyperresponsiveness; airway remodeling; long-acting muscarinic antagonist; long-acting β2 agonist