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Long-acting anticholinergic agents in patients with uncontrolled asthma: a systematic review and meta-analysis.

AbstractSETTING:
A novel effective treatment is necessary for severe asthma.
OBJECTIVE:
To review clinical trials examining the role of tiotropium in patients with poorly controlled asthma despite inhaled corticosteroid use with or without long-acting β₂-agonists.
DESIGN:
A computerised search of electronic databases (Medline, EMBASE and Cochrane Central Register) was performed. Randomised controlled trials of at least a 4-week treatment duration with findings published in English were included.
RESULTS:
Five studies involving 1635 patients were analysed. Compared with a placebo or a double dose of inhaled corticosteroids, the addition of tiotropium increased mean trough and peak forced expiratory volume in 1 second by 97 ml (95%CI 71-122) and 103 ml (95%CI 42-163), respectively. The mean differences in morning peak expiratory flow were 19.2 l/min (95%CI 11.8-26.6). Tiotropium also reduced the risk of severe acute exacerbation (OR 0.73, 95%CI 0.56-0.96) and improved Asthma Quality-of-Life Questionnaire score significantly by 0.10 (95%CI 0.04-0.16). There were no differences in serious adverse events.
CONCLUSION:
The addition of tiotropium may be beneficial for patients with poorly controlled asthma, although exacerbation or safety issues should be clarified in long-term trials before its wide use in asthma.
AuthorsS W Lee, H J Kim, K H Yoo, Y B Park, J-Y Park, J Y Jung, J-Y Moon, M K Byun, S W Kim, Y H Kim
JournalThe international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease (Int J Tuberc Lung Dis) Vol. 18 Issue 12 Pg. 1421-30 (Dec 2014) ISSN: 1815-7920 [Electronic] France
PMID25517806 (Publication Type: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't, Review, Systematic Review)
Chemical References
  • Anti-Asthmatic Agents
  • Bronchodilator Agents
  • Cholinergic Antagonists
  • Scopolamine Derivatives
  • Tiotropium Bromide
Topics
  • Anti-Asthmatic Agents (adverse effects, therapeutic use)
  • Asthma (diagnosis, drug therapy, physiopathology)
  • Bronchodilator Agents (adverse effects, therapeutic use)
  • Chi-Square Distribution
  • Cholinergic Antagonists (adverse effects, therapeutic use)
  • Drug Therapy, Combination
  • Forced Expiratory Volume
  • Humans
  • Lung (drug effects, physiopathology)
  • Odds Ratio
  • Quality of Life
  • Randomized Controlled Trials as Topic
  • Scopolamine Derivatives (adverse effects, therapeutic use)
  • Severity of Illness Index
  • Tiotropium Bromide
  • Treatment Outcome

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