Tiotropium bromide as add-on therapy to inhaled corticosteroids for treating asthma

Abstract

Introduction: Bronchial asthma is becoming increasingly prevalent worldwide. Although first-line therapy with inhaled corticosteroids (ICS) with or without long-acting β2 agonists (LABA) has significantly improved the clinical outcomes of asthma, they cannot provide all asthmatics with good control and thus alternatives or add-on drugs are required. Tiotropium is a long-acting muscarinic antagonist that has been used to treat chronic obstructive pulmonary disease and it has been approved for treating asthma in some countries. This agent has similar bronchodilatory effects to those of LABA and might also have anti-inflammatory and anti-remodeling effects.

Areas covered: Some pivotal clinical trials have found tiotropium effective as an add-on medication for low-to-medium doses of ICS for treating symptomatic asthma and asthma that remains uncontrolled despite ICS plus LABA therapy.

Expert opinion: Whether or not tiotropium has anti-inflammatory and anti-remodeling effects in humans with asthma is an important issue. Predictors that would identify patients who would derive the maximal potential benefit from treatment with tiotropium in addition to their current therapy are also needed. Although the cardiovascular toxicity of tiotropium is less remarkable in asthma than in chronic obstructive pulmonary disease, longer and larger studies are still needed to confirm the safety of tiotropium for treating asthma.

Keywords:

• airway hyperresponsiveness
• airway remodeling
• long-acting muscarinic antagonist
• long-acting β2 agonist

Declaration of interest:

The manuscript has been supported by grants-in-aid for health labour sciences research grant on allergic disease and immunology from the ministry of health labour and welfare Japan. H Matsuse has received lecture fees from AstraZeneca K.K, Astellas Pharma Inc., Kyorin Pharm Inc., Boehringer Ingelheim Japan Inc., and MSD KK.

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