Adding Tiotropium to Teen Asthma Therapy
September 14, 2016
Tiotropium (Spiriva) for Asthma
Therapies for asthma have generally minimized or excluded the use of anticholinergic agents. Current guidelines mention ipratropium, a short-acting anticholinergic agent, in the context of short-term relief, but until very recently, the list of long-term controllers did not include tiotropium bromide, the only long-acting anticholinergic agent. It has been known for many years that anticholinergic agents are effective bronchodilators for asthma and COPD, although they are less potent than beta-agonists in the management of asthma. A recent clinical trial shows that tiotropium bromide is an effective long-term asthma therapy and could be considered the treatment of choice if adrenergic agents are deemed inappropriate.
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Viewpoint:
This trial shows that inhaled tiotropium can be used as a long-term controller for adolescents with moderately severe asthma. For patients requiring maintenance therapy, an inhaled corticosteroid is still the appropriate treatment. Tiotropium should not be the sole long-term therapy, and short-acting bronchodilators should always be available for the relief of "breakthrough" dyspnea and wheeze.
Despite the improvements seen with tiotropium, it must be remembered that no LABAs were permitted in this trial. Therefore, it is not clear whether the use of a tiotropium/ICS combination would be as effective as the more commonly used fixed-dose ICS/LABA combinations. Nor is a tiotropium/ICS fixed-dose combination available for general use. However, it is possible that a triple combination—a LABA, a long-acting muscarinic antagonist, plus an ICS—will be developed in the near future.
Given that fixed-dose combinations of ICS/LABA are readily available and effective, what is the value of a combination of tiotropium and an ICS for the long-term control of asthma?
In fact, some patients do not receive adequate benefit from a LABA, and tolerance to LABAs has been suspected. Other patients dislike using LABAs because of side effects. Furthermore, exacerbations of asthma have been attributed to some LABAs. In each case, the combination of an ICS and an anticholinergic agent might be an appropriate alternative.
ttp://www.medscape.com/viewarticle/868643
Adding Tiotropium to Teen Asthma Therapy
September 14, 2016
Tiotropium (Spiriva) for Asthma
Therapies for asthma have generally minimized or excluded the use of anticholinergic agents. Current guidelines mention ipratropium, a short-acting anticholinergic agent, in the context of short-term relief, but until very recently, the list of long-term controllers did not include tiotropium bromide, the only long-acting anticholinergic agent. It has been known for many years that anticholinergic agents are effective bronchodilators for asthma and COPD, although they are less potent than beta-agonists in the management of asthma. A recent clinical trial shows that tiotropium bromide is an effective long-term asthma therapy and could be considered the treatment of choice if adrenergic agents are deemed inappropriate.
・・・
Viewpoint:
This trial shows that inhaled tiotropium can be used as a long-term controller for adolescents with moderately severe asthma. For patients requiring maintenance therapy, an inhaled corticosteroid is still the appropriate treatment. Tiotropium should not be the sole long-term therapy, and short-acting bronchodilators should always be available for the relief of "breakthrough" dyspnea and wheeze.
Despite the improvements seen with tiotropium, it must be remembered that no LABAs were permitted in this trial. Therefore, it is not clear whether the use of a tiotropium/ICS combination would be as effective as the more commonly used fixed-dose ICS/LABA combinations. Nor is a tiotropium/ICS fixed-dose combination available for general use. However, it is possible that a triple combination—a LABA, a long-acting muscarinic antagonist, plus an ICS—will be developed in the near future.
Given that fixed-dose combinations of ICS/LABA are readily available and effective, what is the value of a combination of tiotropium and an ICS for the long-term control of asthma?
In fact, some patients do not receive adequate benefit from a LABA, and tolerance to LABAs has been suspected. Other patients dislike using LABAs because of side effects. Furthermore, exacerbations of asthma have been attributed to some LABAs. In each case, the combination of an ICS and an anticholinergic agent might be an appropriate alternative.
ttp://www.medscape.com/viewarticle/868643