RT Journal Article SR Electronic T1 Tiotropium provides sustained bronchodilation in asthmatics with persistent airflow obstruction uncontrolled despite treatment in accordance with guidelines JF European Respiratory Journal JO Eur Respir J FD European Respiratory Society SP P2187 VO 40 IS Suppl 56 A1 Huib Kerstjens A1 Pierluigi Paggiaro A1 Mark Vandewalker A1 Ekkehard Beck A1 Michael Engel A1 Ralf Sigmund A1 Wolfgang Seibold A1 Petra Moroni-Zentgraf A1 Eric Bateman YR 2012 UL http://erj.ersjournals.com/content/40/Suppl_56/P2187.abstract AB Introduction: In some asthmatics airflow obstruction persists despite high-dose (HD) inhaled corticosteroid (ICS) and long-acting β2-agonist (LABA) use. In a recent study, adding a long-acting anticholinergic (tiotropium) showed favourable effects over 8 weeks (wks) (Kerstjens HA, et al. JACI. 2011).Methods: In 2 replicate 48-wk, doubleblind, parallel-group trials a total of 912 asthmatics with postbronchodilator (BD) FEV1 <80% predicted and asthma control questionnaire score ≥1.5 while on at least HD ICS+LABA were randomised to additional tiotropium Respimat® 5 mcg or placebo. Prespecified co-primary endpoints included peak and trough FEV1 at 24 wks. Secondary endpoints were FEV1 at other time-points, FVC, and daily PEFs.Results: Baseline characteristics were similar between trials and treatment groups (mean post-BD FEV1 62% [±13]). Mean change from baseline tiotropium vs placebo after 24 wks in peak pre-BD FEV1 was 86 (±34) mL (P=0.01) or 154 (±32) mL greater (P<0.001), and in trough FEV1 88 (±34) mL (P=0.01) or 111 (±30) mL greater (P<0.001) in trials 1 and 2, respectively. Improvements in FVC and daily PEFs were also significantly greater with tiotropium. There were no signs of tachyphylaxis over 48 wks. No deaths occurred; adverse events were balanced across treatments in both trials.Conclusion: In asthmatics uncontrolled despite at least HD ICS+LABA, adding tiotropium provided significant lung function improvement at 24 wks which was sustained over 48 wks. Tiotropium is likely to improve severe uncontrolled asthma on top of treatment in accordance with guidelines.Study supported by Boehringer Ingelheim and Pfizer.