Long-acting anticholinergics in the treatment of severe asthma with irreversible airway obstruction

Abstract

Introduction.Patients with severe asthma tend to have impaired lung function and irreversible airway obstruction (IAO), which can lead to lower sensitivity of these patients to standard therapy. It is assumed that long-acting anticholinergic drug (tiotropium bromide) can be useful in severe asthma as additional therapy.

The aim of the study was to evaluate efficacy of tiotropium bromide in patients with severe asthma and IAO.

Methods.The study was held in 19 patients with severe uncontrolled asthma who have been receiving high-dose inhaled corticosteroids in combination with long-acting β₂-agonists and demonstrated IAO (postbronhodilator FEV₁/FVC≤70% pred and/or postbronhodilator FEV₁≤80% pred). Within this study all patients have been receiving18 μg of tiotropium bromide daily in addition to the current therapy during 12 weeks. The level of asthma control and lung function parameters were assessed initially and after12 weeks of treatment. To compare variables before and after treatment the Wilcoxon test was used. Data are presented as median (range).

Results.After 12 weeks of treatment significant improvement in the level of asthma control (by ACQ-5 from 2.6 (1.4-3.4) to 1.6 (1.0-2.2), p=0.001), increase of postbronhodilator FEV₁ (from 57 (49-66) to 61 (55-79) % pred, p=0.006), and decrease of residual volume (from 185.3 (165.3-250.0) to 168.9 (141.7-189.3) %pred, p=0.046) were revealed.

Conclusion.Thus, addition of tiotropium bromide to standard therapy (high-dose inhaled corticosteroids in combination with long-acting β₂-agonists) in patients with severe uncontrolled asthma with IAO can improve the level of asthma control and the lung function.