title: Tiotropium for the treatment of adolescents with moderate to severe symptomatic asthma: a systematic review with meta-analysis.
abstract: BACKGROUND
  The role of tiotropium for the treatment of adolescents with asthma has not yet been clearly defined.
  
  
  OBJECTIVE
  To assess the efficacy and safety of inhaled tiotropium in adolescents with moderate to severe symptomatic asthma.
  
  
  METHODS
  Randomized, placebo-controlled trials were included in this systematic review. Primary outcomes were peak and trough forced expiratory volume in 1 second (FEV1).
  
  
  RESULTS
  Three studies (approximately 1,000 patients) were included. Tiotropium was associated with significant improvements in FEV1 peak (mean change from baseline) by 120 mL (P < .001) and trough by 100 mL (P < .001) compared with placebo. Tiotropium significantly reduced the percentage of patients who experienced an Asthma Control Questionnaire 7 worsening episode defined as a change from trial baseline of 0.5 points or more compared with placebo (2.1% vs 4.8%, number needed to treat = 38) and also was associated with a significantly decreased in the number of patients with at least one exacerbation compared with placebo (17.6 vs 23.8%, number needed to treat = 16). Finally, no significant differences were found in rescue medication use, withdrawals, withdrawals due to adverse events (AEs), AEs (27.3% vs 27.1%), and serious AEs (6.5% vs 7.1%). Tiotropium in doses of 2.5 μg once daily or 5.0 μg once daily resulted in equivalent effects.
  
  
  CONCLUSIONS
  Tiotropium was well tolerated and efficacious as an addition to maintenance treatment with an inhaled corticosteroid or an inhaled corticosteroid plus a long-acting β-agonist in adolescents with moderate to severe asthma. Available data do not suggest an advantage of the 5-μg once-daily dose (used in adults) compared with the 2.5-μg once-daily dose of tiotropium.
authors.affiliation: Department of Emergency, Hospital Central de las Fuerzas Armadas, Montevideo, Uruguay. Electronic address: gustavo.javier.rodrigo@gmail.com.
authors.forename: Gustavo J
authors.initials: GJ
authors.lastname: Rodrigo
authors.affiliation: Departments of Pediatrics and Family Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: José A
authors.initials: JA
authors.lastname: Castro-Rodríguez
mesh_terms: D000293:Adolescent; D001249:Asthma / Q000188:drug therapy* / Q000473:pathology; D001993:Bronchodilator Agents / Q000009:adverse effects / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D012129:Respiratory Function Tests; D011795:Surveys and Questionnaires; D000069447:Tiotropium Bromide / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D001993:Bronchodilator Agents; D000069447:Tiotropium Bromide