Abstract
BACKGROUND: A number of asthmatic subjects still use oral corticosteroids despite the use of high dose inhaled corticosteroids (ICS), long-acting B2 agonists (LABAs) and antileukotrienes. The aim of the study was to evaluate the ability of Tiotropium, a long-acting antimuscarinic bronchodilator (LAMAs) as an add on therapy to high-dose ICS/LABA in patients requiring OCS for effective asthma control.
METHODS: For eligibility, patients, aged 20-50 years, were required to have had severe persistent asthma for at least 12 months before enrollment and they were required to have needed daily or alternate-day OCSs for asthma control for the last 6 months before enrollment. Of the 422 asthmatic patients, 33 (8%) patients not controlled on combined ICS/LABA needed OCSs were assigned to Tiotropium 5 ug group (n=12), the Tiotropium 2.5 ug group (n=10) and without Tiotropium group (n=11).
RESULTS: At the end point (12 weeks), Tiotropium 5ug and 2.5ug once daily reduced OCS requirements by 56.0% and 44.1% respectively, whereas patients without Tiotropium increased OCS requirements by 97%. Oral steroids were eliminated in 52%, 36% and 0% of patients in the Tiotropium 5ug and 2.5ug groups and without Tiotropium group, respectively. Tiotropium treatment produced significant increases in pulmonary function. Moreover, within-group comparisons revealed that FEV1 was significantly improved between baseline and endpoint in both active treatment groups despite reduce prednisone use.
CONCLUSION: Tiotropium is an effective alternative to systemic corticosteroids in patients with severe persistent asthma.
- Copyright ©the authors 2016
