By Lilian Anekwe
The COPD drug tiotropium is as good as salmeterol and better than increasing the dosage of inhaled corticosteroids in the management of adult patients with asthma, new research suggests.
British Thoracic Society guidelines recommend GPs using long-acting beta agonists at step 3- as an add-on in patients uncontrolled after with a short-acting beta agonist and inhaled corticosteroids.
But recent studies have questioned the safety of LABA therapy, and the latest Drug Safety Update reminded GPs to minimise their use of LABAs and review LABA therapy regularly, prescribe the lowest effective dose, and stop if there is no benefit.
Evidence for the usefulness of anticholinergic drugs like tiotropium in asthma has been limited. In the new study 210 adults with uncontrolled asthma were initially treated with 80 mcg of beclomethasone for four-weeks then randomised to one of three groups: doubling the beclamethasone dose or adding in tiotropium or salmeterol.
Patients who received tiotropium had a morning peak expiratory flow (PEF) that was 25.8 l/min higher than patients receiving a double dose of beclometasone, and an evening PEF 35.3 l/min higher.
Tiotropium patients also had a significantly higher proportion of asthma-control days and scored better on the Asthma Control Questionnaire than those on the higher steroid dose.
Tiotropium treatment significantly improved evening PEF when compared to salmeterol, with a difference of 10.6 l/min, but there were no significant differences in other outcomes.
Dr Stephen Peters, professor of pulmonary medicine at Wake Forest University in North Carolina, said: ‘Pulmonary function remains an important element of asthma control, and improvements in pulmonary function that were induced by tiotropium were accompanied by improvements in both asthma symptoms and the proportion of asthma-control days.’
Tiotropium asthma boost