Adding Tiotropium to Asthma Maintenance: Are There Clinical Benefits?

Researchers conducted an analysis of 5 double-blind, placebo-controlled trials (N=2926) in asthma
Researchers conducted an analysis of 5 double-blind, placebo-controlled trials (N=2926) in asthma

This article is part of MPR's coverage of the American Academy of Allergy, Asthma & Immunology, taking place in Orlando, Florida. Our staff will report on medical research related to asthma and other respiratory conditions, conducted by experts in the field. Check back regularly for more news from AAAAI/WAO 2018.


An international group of researchers examined the consistency of the clinical benefits associated with tiotropium administered via the Respimat® inhaler across multiple Global Initiative for Asthma (GINA) asthma severity groups. They found that the addition of tiotropium to maintenance therapy improves lung function and controls symptomatic asthma in adults across all asthma severity groups.  Their research was presented at the 2018 joint congress of the American Academy of Allergy, Asthma & Immunology and the World Allergy Organization, held March 2-5, 2018, in Orlando, Florida.

Post hoc analysis was conducted on data from 5 double-blind, placebo-controlled trials including adult patients (N=2926) with asthma. The effects of tiotropium 5 mcg or 2.5 mcg on peak forced expiratory volume in the first second of expiration (FEV1) within 3 hours, trough FEV1, and responder rates on the Asthma Control Questionnaire (ACQ-7) were examined in patients with asthma across various GINA severity groups.

The researchers found that tiotropium offers consistent improvement in peak and trough FEV1 values across GINA steps 2-5. The placebo-corrected peak FEV1(0–3h) improvements after tiotropium 5 mcg and 2.5 mcg were: Step 2 (week 8) 135 mL (95% CI: 84-187) and 155 mL (95% CI: 103-206); Step 3 (week 24) 187 mL (95% CI: 139-235) and 235 mL (95% CI: 187-283); Step 4 (week 24) 111 mL (95% CI: 63-159) and 181 mL (95% CI: 35-326); and Step 5 (week 24; 5 mcg only) 164 mL (95% CI: 5-323).

Improvement trends in ACQ-7 responder rates were observed with tiotropium 5 mcg and 2.5 mcg vs placebo; odds ratios were: Step 3, 1.17 (95% CI: 0.85-1.61) and 1.26 (95% CI: 0.91-1.74); Step 4, 1.36 (95% CI: 1.03-1.78) and 2.12 (95% CI: 0.98, 4.79); and Step 5 (5 mcg only), 1.85 (95% CI: 0.68-5.06).

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These results suggest that adding tiotropium to standard maintenance therapy improves lung function and asthma control in adults regardless of GINA asthma severity classification. 

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Reference

Buhl R, FitzGerald JM, Meltzer E, et al. Efficacy of once-daily tiotropium Respimat® on lung function and asthma control in adults with asthma at GINA Steps 2–5. Poster presentation at: 2018 AAAAI/WAO Joint Congress; March 2-5, 2018; Orlando, FL. Abstract 662.