Efficacy of Anticholinergic Drugs in Asthma
Efficacy of Anticholinergic Drugs in Asthma
From the studies conducted to date, tiotropium is a candidate to become a new therapeutic option in patients with asthma, in particular as step-up therapy in patients with severe persistent asthma who have still persistent bronchoconstriction and who are still symptomatic despite maximal therapy, including LABA.
The results of noninferiority compared with salmeterol in patients with moderate asthma, in the studies by Peters et al. and Bateman et al., also make possible its use as an alternative to LABA in patients whose symptoms are not well controlled by ICS alone. In this context, an important observation is that the effectiveness of tiotropium in these patients appears to be independent of genetic polymorphisms of the β2-receptors. In this regard, the study by Bateman et al. considered only asthmatics with the B16-Arg/Arg genotype, and the demonstration of similar results with the study of Peters et al., despite the same baseline characteristics of the patients (mean prebronchodilator FEV1 75 and 71.5%, respectively), suggests that the B16-Arg/Arg polymorphism does not play a role in the response to tiotropium.
Finally, the addition of tiotropium seems to be particularly recommended in patients with COPD and a history of asthma, according to the results obtained in the study by Magnussen et al. This group of patients represents a subgroup of COPD patients with more severe disease and poor quality of life, and the availability and efficacy of tiotropium in these patients may represent a valid additional therapeutic option.
Positioning of Tiotropium in Asthma
From the studies conducted to date, tiotropium is a candidate to become a new therapeutic option in patients with asthma, in particular as step-up therapy in patients with severe persistent asthma who have still persistent bronchoconstriction and who are still symptomatic despite maximal therapy, including LABA.
The results of noninferiority compared with salmeterol in patients with moderate asthma, in the studies by Peters et al. and Bateman et al., also make possible its use as an alternative to LABA in patients whose symptoms are not well controlled by ICS alone. In this context, an important observation is that the effectiveness of tiotropium in these patients appears to be independent of genetic polymorphisms of the β2-receptors. In this regard, the study by Bateman et al. considered only asthmatics with the B16-Arg/Arg genotype, and the demonstration of similar results with the study of Peters et al., despite the same baseline characteristics of the patients (mean prebronchodilator FEV1 75 and 71.5%, respectively), suggests that the B16-Arg/Arg polymorphism does not play a role in the response to tiotropium.
Finally, the addition of tiotropium seems to be particularly recommended in patients with COPD and a history of asthma, according to the results obtained in the study by Magnussen et al. This group of patients represents a subgroup of COPD patients with more severe disease and poor quality of life, and the availability and efficacy of tiotropium in these patients may represent a valid additional therapeutic option.