Tiotropium as an Add-on Treatment Option for Severe Uncontrolled Asthma in Preschool Patients

Figures & data

Figure 1 Design of the retrospective study.

Abbreviations: ICS, inhaled corticosteroids; LABA, long-acting β₂-agonists; SCS, systemic corticosteroids.

Table 1 Patient and Control Demographics Before Switching to ICS/LABA/Tiotropium Treatment

Demographic Data 6 Months Before ICS/LABA/LAMA Treatment	ICS/LABA/LAMA (n=21)	Controls (n=42)	P
Age, months (range)	21.7 (6–46)	21.7 (6–46)
Sex (male/female), n	11/10	22/20
Family history of atopy, n (%)	11 (52.4)	0	<0.001
Atopic dermatitis, n (%)	6 (28.6)	0	<0.001
Allergy (prick ≥3 mm), n (%)	6 (28.6)	0	<0.001
Passive smoke exposure	2 (9.5)	NA
Duration of asthma, months, median (range)	23 (4–46)	NA
ICS/LABA, %	42	NA
ICS/LABA/LTRA, %	58	NA
Fluticasone, µg, median daily dose (range)	200 (100–200)	NA
Duration of ICS therapy, months, median (range)	22 (5–44)	NA

Note: For comparison the Fisher test was applied.

Abbreviations: ICS, inhaled corticosteroid; LABA, long-acting β₂-agonist; LAMA, long-acting muscarinic receptor antagonist; LTRA, leukotriene receptor antagonist; NA, not applicable.

Figure 2 (A) Systemic corticosteroid administration; (B) physician visits; (C) hospitalisations; (D) use of antibiotics. Data are shown as mean±standard error of mean. Pre=observation period 1 (up to 6 months before start of ICS/LABA/tiotropium therapy); post=observation period 2 (up to 6 months after start of ICS/LABA/tiotropium therapy). Treatment differences of tiotropium, physician visits and antibiotic use between pre and post observation were evaluated by the Wilcoxon–Mann–Whitney test. Abbreviations: ICS, inhaled corticosteroids; LABA, long-acting β₂-agonist.

Table 2 Treatment Response in Patients with and without LTRA Use

	Before Tiotropium			Plus Tiotropium
	ICS without LTRA	ICS with LTRA	P	ICS without LTRA	ICS with LTRA	P
	(n=9)	(n=12)		(n=9)	(n=12)
Systemic steroids	n=13	n=33	0.275	n=4	n=10	0.630
Mean	1.86	2.75		0.57	0.83
No data	2	0		2	0
Hospitalisation	n=3	n=16	0.100	n=0	n=1	0.461
Mean	0.43	1.33		0	0.08
No data	2	0		2	0
Antibiotic use	n=13	n=21	0.834	n=6	n=8	0.680
Mean	1.86	1.75		0.857	0.67
No data	2	0		2	0
Physician visits	n=68	n=89	0.758	n=44	n=54	0.672
Mean	9.71	8.90		6.29	5.4
No data	2	2		2	2

Notes: Absolute numbers of events (n) and average values (event/number of patients) are shown. For comparison the Wilcoxon test was applied.

Abbreviations: ICS, inhaled corticosteroids; LTRA, leukotriene receptor antagonist.

Figure 3 Parental assessment of treatment according to the Likert scale (0=no improvement; 10=very good improvement; children with asthma only).