COPD Drug Spiriva (Tiotropium Bromide) Helps Patients With Poorly Controlled Asthma

Spiriva (Tiotropium Bromide) added to low-dose inhaled corticosteroids was found to be effective in the treatment of adults with poorly controlled asthma, researchers from NHLBI (National Heart, Lung, and Blood Institute) reported in an article published in The New England Journal of Medicine (NEJM). Tiotropium Bromide is commonly used to treat COPD (chronic obstructive pulmonary disease).

NHLBI Acting Director Susan B. Shurin, M.D., said:

This study’s results show that tiotropium bromide might provide an alternative to other asthma treatments, expanding options available to patients for controlling their asthma. The goal in managing asthma is to prevent symptoms so patients can pursue activities to the fullest.

The authors report that adding tiotropium bromide to inhaled corticosteroids (low dose) is better at controlling asthma than just doubling the inhaled corticosteroids, and equally effective as adding salmeterol, a long-acting agonist. Their findings were presented at the Annual Congress of the European Respiratory Society, Barcelona, Spain.

Patients with poorly controlled asthma are currently usually treated with increased inhaled corticosteroids, or supplementing with long-acting beta agonists, such as salmeterol. However, elevated doses of corticosteroids don’t work for everyone, and have a considerable risk of side effects. Long-acting beta agonists have recently been linked with worsening asthma symptoms, hospitalization and even death (rare).

Stephen Peters, M.D., Ph.D., study leader, of Wake Forest University Baptist Medical Center, Winston-Salem, N.C. , said:

Tiotropium relaxes smooth muscle in the airways through a different mechanism than beta agonists, and thus may help people who do not respond well to currently recommended treatments. Further analysis of the study data will help us better understand which patients respond best to tiotropium. Then we will need to conduct longer-term studies to establish its safety for asthma patients and to determine its effect on the frequency and severity of asthma exacerbations.

The study compared three treatment methods for poorly controlled asthma in adults:

• Just doubling the inhaled corticosteroid dose
• A low dose of inhaled corticosteroids supplemented with a long-acting beta agonist, such as slameterol
• A low dose of inhaled corticosteroids supplemented with a long-acting anticholinergic drug, such as tiotropium bromide

Parts of the autonomic nervous system that cause muscles in the airways to contract are blocked by anticholinergics (tiotropium bromide).

The study monitored 210 adults with poorly controlled asthma on low doses of inhaled corticosteroids alone. Each treatment lasted 14 weeks with a two-week break in between; the whole study lasted forty-eight weeks.

Tiotropium bromide (Spiriva) proved to be effective using numerous measurements for asthma control, including patients’ day-to-day lung function, as well as the total number of days the patients had no asthma symptoms and did not need their albuterol rescue inhalers.

At the start of the trial, the patients’ average number of such “asthma control days” was 77 annually – this was extrapolated from the treatment period.

The patients had an extra 19 symptom-free days on average when their corticosteroid dosage was doubled, compared to an extra 48 days on the low-dose corticosteroids supplemented with tiotropium bromide.

James Kiley, Ph.D., director of the NHLBI’s Division of Lung Diseases, said:

Much research over the last century has explored the role of cholinergic mechanisms [which constrict the airways] and anticholinergic therapies in asthma. However, this is the first study to explore adding an anticholinergic inhaler to low-dose inhaled corticosteroids. The Asthma Clinical Research Network is designed to address exactly these kinds of practical and important management questions, with the ultimate goal of helping asthma patients.

In the NEJM article, the authors concluded:

When added to an inhaled glucocorticoid, tiotropium improved symptoms and lung function in patients with inadequately controlled asthma. Its effects appeared to be equivalent to those with the addition of salmeterol.