WHAT IS THE ROLE OF TIOTROPIUM IN ASTHMA? A SYSTEMATIC REVIEW WITH META-ANALYSIS.
Rodrigo GJ, Castro-Rodríguez JA.
Chest. 2014 Oct 16. doi: 10.1378/chest.14-1698.
The role of tiotropium for the treatment of asthma has not yet been clearly defined. The aim of this systematic review was to assess the efficacy and safety of tiotropium in asthma patients.
Randomized, placebo-controlled trials were included. Primary outcomes were peak and trough forced expiratory volume in the first second (FEV1), and morning and evening peak expiratory flow (PEF).
Thirteen studies (4,966 patients) were included. Three different therapeutic protocols were identified. Tiotropium as add-on to inhaled corticosteroids (ICS) showed statistically and clinically significant increases in PEF (22-24 L/min) and FEV1 (140-150 mL). Also, tiotropium decreased the rate of exacerbations (Number need to treat for benefit [NNTB] = 36) and improved asthma control. The use of tiotropium in patients poorly controlled despite the use of medium to high doses of ICS was not inferior to salmeterol. Finally, the use of tiotropium as add-on ICS/salmeterol combination increased pulmonary function in a clinically significant magnitude, reduced asthma exacerbations (Relative risk = 0.70; 95% CI: 0.53 to 0.94, p<0.02, I2=0%, NNTB = 17), and improved asthma control compared with ICS/salmeterol. Tiotropium was well tolerated and no potential safety signals were observed.
Tiotropium resulted non-inferior to salmeterol and superior to placebo in patients with moderate-severe asthma who were not adequately controlled by ICS or ICS/salmeterol. Major benefits were concentrated in the increase in lung function, and in the case of severe asthmatics, in the reduction of exacerbations.