Tiotropium in asthma: what is the evidence and how does it fit in?
Despite current therapeutic approaches asthma remains uncontrolled in a significant proportion of patients. Short-acting anticholinergic bronchodilators have a very long history of use in asthma, and recent data confirms the importance of acetylcholine as both a bronchoconstrictor and as a regulator of inflammation and remodeling in the lungs. Data from a comprehensive clinical trial programme, as well as use in primary care, show the efficacy and safety of tiotropium in adults with mild to moderate asthma when it is added to ICS and in severe asthma when it is added to high doses of ICS plus LABA, as well as in adolescents. Tiotropium is cost effective and its benefits are not restricted to particular phenotypes, making it a useful addition to the therapeutic options recommended by the Global Initiative for Asthma (GINA) for people with poorly controlled asthma at steps 4 & 5.
Royal Devon & Exeter Hospital, Exeter, EX2 5DW UK.
David M G
DM
Halpin
Asthma; Long-acting anticholinerics; Tiotropium
Am J Respir Crit Care Med. 2000 Jun;161(6):1862-8
10852758
J Allergy Clin Immunol. 2013 Nov;132(5):1068-1074.e1
24084072
Ann Allergy Asthma Immunol. 2007 Mar;98(3):245-51
17378255
Pulm Pharmacol Ther. 1998;11(5-6):381-392
10208827
J Allergy Clin Immunol. 2016 Aug;138(2):441-450.e8
26960245
Thorax. 2005 Sep;60(9):740-6
16055613
J Asthma Allergy. 2015 Jan 14;8:1-13
25609985
Respir Med. 2007 Jun;101(6):1218-28
17178217
J Allergy Clin Immunol Pract. 2016 Jan-Feb;4(1):104-13.e2
26563670
Am J Respir Crit Care Med. 2004 Oct 15;170(8):836-44
15256389
J Allergy Clin Immunol. 2015 Apr;135(4):896-902
25441637
Lancet Respir Med. 2015 May;3(5):367-76
25682232
N Engl J Med. 2012 Sep 27;367(13):1198-207
22938706
Allergy Asthma Immunol Res. 2011 Oct;3(4):217-25
21966601
Life Sci. 1999;64(6-7):457-64
10069510
Clin Exp Allergy. 2012 May;42(5):706-11
22515391
Cochrane Database Syst Rev. 2004;(3):CD003269
15266477
Trends Pharmacol Sci. 2007 Jun;28(6):257-62
17466387
Clin Exp Allergy. 2010 Aug;40(8):1266-75
20337647
Eur Respir J. 1999 Jul;14(1):32-8
10489826
N Engl J Med. 2006 Mar 16;354(11):1206-8; author reply 1206-8
16548074
Trends Pharmacol Sci. 2015 Mar;36(3):164-71
25511176
J Allergy Clin Immunol. 1999 Jan;103(1 Pt 1):88-92
9893190
J Allergy Clin Immunol. 2011 Aug;128(2):315-22
21807250
Am J Respir Crit Care Med. 1996 Oct;154(4 Pt 1):876-80
8887578
Br J Pharmacol. 2011 May;163(1):44-52
21198547
Chest. 2005 Oct;128(4):1974-9
16236844
Eur Respir J. 2007 Oct;30(4):653-61
17537779
N Engl J Med. 2010 Apr 1;362(13):1169-71
20181964
Am Rev Respir Dis. 1990 Jun;141(6):1559-68
2350099
Respir Med. 2008 Dec;102(12):1681-93
18815019
Eur Respir J. 1998 Nov;12(5):1209-18
9864023
Allergy. 2007 Jun;62(6):668-74
17508972
J Allergy Clin Immunol. 2000 Dec;106(6):1033-42
11112883
PLoS One. 2015 Apr 20;10(4):e0124109
25894430
Respir Med. 2015 Mar;109(3):329-38
25661281
Respir Res. 2006 May 09;7:73
16684353
Pulm Pharmacol Ther. 2010 Aug;23(4):345-54
20362689
N Engl J Med. 1997 Nov 13;337(20):1405-11
9358137
Appl Health Econ Health Policy. 2014 Aug;12(4):447-59
24974107
Respir Res. 2014 Jun 03;15:61
24890738
N Engl J Med. 2010 Oct 28;363(18):1715-26
20979471
Thorax. 2011 Oct;66(10):910-7
21106547
Life Sci. 2012 Nov 27;91(21-22):969-72
23141771
Clin Rev Allergy Immunol. 2006 Oct-Dec;31(2-3):119-30
17085788
Thorax. 1992 Feb;47(2):76-83
1549827
Respir Med. 2014 Sep;108(9):1268-76
25081651
Endocrinology. 2004 May;145(5):2498-506
14764638
Pak J Med Sci. 2016 Mar-Apr;32(2):462-5
27182262
Respir Res. 2015 Feb 07;16:20
25851298
J Pediatr. 2010 Aug;157(2):276-281.e3
20472251
Expert Rev Respir Med. 2012 Jun;6(3):309-19
22788945
Am J Respir Crit Care Med. 2005 Jun 1;171(11):1202-8
15778490
Br J Clin Pharmacol. 2003 Nov;56(5):494-500
14651722
Am J Respir Crit Care Med. 2005 May 15;171(10):1096-102
15695490
Eur Respir Rev. 2009 Jun;18(112):105-12
20956130
Respir Med. 2015 Jan;109(1):63-73
25464907
BMJ. 1993 Aug 14;307(6901):446
8374471
Pharmacol Ther. 2007 Aug;115(2):208-22
17597218
J Allergy Clin Immunol. 2010 Mar;125(3):600-8, 608.e1-608.e6
20153029