Managing Severe Asthma: A Role for the Long-Acting Muscarinic Antagonist Tiotropium.

Eckard Hamelmann

doi:10.1155/2018/7473690

Abstract

Severe asthma is associated with substantial morbidity and mortality. Therapies must be maximized to gain control of a patient's severe asthma; however, avoiding overtreatment is also important. The mainstays of asthma maintenance treatment are inhaled corticosteroids (ICS) and long-acting β2-agonsits (LABAs), with the option of supplementary add-on treatments. New add-on treatments for severe asthma have emerged over the past two decades, including personalized biological therapies that are guided by a patient's asthma phenotype. In addition, the long-acting muscarinic antagonist tiotropium has been recommended as an add-on treatment for severe asthma. Phase III clinical trials have shown tiotropium in combination with ICS/LABA to be efficacious in patients with severe asthma. Further analyses of clinical trial data have indicated that there is no benefit in stratifying patients by phenotype to predict tiotropium efficacy. Furthermore, health economic studies suggest tiotropium to be a cost-effective treatment in patients with severe asthma. This review will present the evidence surrounding the role of tiotropium in severe asthma and will discuss the use of tiotropium add-on therapy before personalized medicine strategies in the stepwise process of gaining asthma control.

Highlights

For the estimated 358 million patients worldwide who live with asthma, management of their disease has the overarching goal of gaining complete control and minimizing future risk [1]
This review will present the evidence surrounding the role of tiotropium in severe asthma and will discuss the use of tiotropium add-on therapy before personalized medicine strategies in the stepwise process of gaining asthma control
In addition to lung function improvements, the analysis indicated that asthma symptoms measured by the ACQ-7 score and the risk of asthma worsening were consistently improved with tiotropium therapy in patients with severe asthma across a range of serum immunoglobulin E (IgE) levels

Summary

Introduction

For the estimated 358 million patients worldwide who live with asthma, management of their disease has the overarching goal of gaining complete control and minimizing future risk [1]. Despite treatment in accordance with guidelines, including the use of inhaled corticosteroids (ICS) and/or longacting β2-agonists (LABA), a proportion of patients continue to have impaired control and experience the symptoms of asthma [2, 5, 6] For these uncontrolled patients, treatment may be increased in the form of dosage or employing additional therapies [5]. Personalized therapy plans can be tailored to each patient in accordance with their subtype of the disease (see other reviews in this special issue) Clinical guidelines reflect these developments, with the GINA 2018 report suggesting patients with severe asthma who remain uncontrolled on ICS/LABA may be phenotyped and treated with appropriate biological therapies [5]. This review will present the evidence surrounding the role of tiotropium add-on therapy in severe asthma management and discuss how it may be a broadly effective and economical therapy for use before personalized medicine strategies

Where Do LAMAs Fit into Severe Asthma Management?

Background treatment

The Role of LAMAs in Personalized Therapy

LAMAs: A Cost-Effective Therapy for Severe Asthma?

Findings

Conclusions